Form Downloads / Fees / Services

Download PDF Forms

Please click links below to download and print:

• Contract For Services
• Fees and Services
• Authorization to Release Information
• Release of Liability – Client Transportation
• Determining the Need for Help – Booklet

Fees and Services

Preliminary Information Regarding Geriatric Care Management & Professional Fiduciary Services:

Complimentary for 30-minute phone or in-office session.
A $500 refundable retainer will be initially charged at the time that services are engaged.

Psychosocial Assessment:

Formal written report of client’s functioning, recommendations for services, change in level of care regarding current living situation, interventions and plan of care to be established. — $115/hour

Care Management (Aging Life Care Specialist) & Professional Fiduciary Services:

Coordination of services, transport to medical appointments, ongoing advocacy and evaluation of clients to make certain daily needs are met, education for families in negotiating social service and health system, acting as liaison for families and/or caregivers out-of-area, assist in relocation to alternative living situation. A minimum 1 hour visit each month is required. — $115/hour

Mediset Visits:

Includes a visit by a licensed nurse to set up medications bi-monthly or monthly in a mediset, maintain a medication list, and take vitals.  — $115/visit

Assistant Aging Life Care Manager (Para-Professional):

Coordination of services, transport to medical appointments, ongoing advocacy and evaluation of clients to make certain that daily needs are met under the Supervision of an Aging Life Care Specialist.  Coordination of a move, more complex shopping such as furniture, clothing, etc.   Lab appts., podiatry, dental, etc. at the discretion of the Aging Life Care Specialist overseeing the case — $75/hour

Support Services:

Faxes, phone calls, shopping for personal supplies/groceries, deliveries, notary public, etc. by office staff. — $47/hour

Medical Power of Attorney / Mental Health Power of Attorney Appointments:

One-time fee. Includes consultation and account setup.

— $450 Individual / $600 Couple

Payments:

• Payments are due in our office 15 days from the date on the invoice. We do not accept payment by credit card. A 10% late payment charge will be applied if payment is not received within 15 days of the date on the invoice.
• Per-hour services are pro-rated at 6-minute intervals.
• We do not charge mileage, client setup fees, or administrative fees.  Travel time is billed at the assigned rate.
• No additional charges for evening/weekend emergency calls – normal rates apply. We encourage routine matters and non-emergency calls be directed to our office during regular business hours, Monday – Friday 8 AM – 5 PM.

Effective 2.1.17