Let us Customize your Documents

All questions related to customization are optional, but the more you answer the more complete your documents. After purchasing we send an email with your receipt and questionnaire.

1.  Company Name:
2.  Company Address:
3.  Company Phone Number:
4.  Company Fax Number:
5.  What are your office hours and days open?
6.  Company email address.
7.  Does your company have a catch phrase?
8.  What is your fee schedule?
9.  What are your payor types?  e.g. Private Pay, Medicaid,
      Insurance, Workers Compensation.
10.  What is your coverage area?
11.  Governing Body Chairperson Name:
12.  Organization List E.g. Jane Doe Administrator, John Henry Alternate Administrator, etc.
13.  Does your company utilize any consulting firms?
14.  What is the Dress Code (We have one in place if you do not have one prepared)?
15.  What is your company Mission Statement and Goals (We have one in place if you do not have one prepared)?
16.  We also need a copy of your logo.
17. Is your company seeking Joint Commission, ACHC, or CHAP accreditation? If so, which one?

Let our industry experience guide you to success. We can assist you with every aspect of a home health agency. We have provided solutions to hundreds of agencies from Hawaii to Alaska and Coast to Coast. Get as much or as little assistance as you need.

Give us a call and let us know about your needs.
1-877-967-5493

Email:
info@HomeHealthForms.com

How to Start a Home Health Agency Videos

Part One

Part Two

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