Follow the steps to complete the admission agreement form online.

1. Click ‘Get Form’ button to access the admission agreement form and open it in your preferred editing tool.
2. Fill in the facility information section. Provide the name, address, license number, and contact details of the facility.
3. Complete the resident information section. Enter the name of the resident, the responsible person, their address, social security number (if applicable), date of birth, and date of admission.
4. In the basic services section, review the services provided by the facility and check the boxes that correspond to the needs and preferences of the resident. Include additional services if necessary on an attached sheet.
5. Specify the rates for basic services. Enter the monthly private pay and SSI/SSP rates as required in the designated spaces.
6. Outline any optional items and services that the resident may be interested in. List these services along with their costs.
7. Provide details about third-party services, if applicable. Indicate whether they are available or attach necessary information if applicable.
8. Fill out the payment provisions section. Clearly state the billing policies, due dates, and accepted payment methods.
9. Complete sections related to rate changes, refund policies, telephone services, and house rules, ensuring all required information is thorough and accurate.
10. Review and finalize any additional required sections regarding grievances, personal rights, termination conditions, and relocation policies.
11. At the end of the form, ensure signatures of the resident, responsible person, and licensee are obtained. Each party should date the agreement.
12. Save changes to the form, then download, print, or share the completed document as required.

Complete your admission agreement online today to streamline the admission process!