Client Application

If you are in need of the services GYC Senior Care offers and would like to work with us:

  1. Please download the forms at the bottom of this page,
  2. Fill them out on your computer,
  3. And send them back through this client application form.

We’ll be happy to get back to you in a timely manner.
Signatures on the forms are not mandatory and can be done when meeting our Specialist.

Contact Info

Client Forms

Client Service Agreement

  • Authorization and agreement for home services.


Client Service Plan

  • List of services.


ACH Authorization Form

  • Authorization form for ACH payment.


Scope of Home Care Services

  • Detailed breakdown of the scope of GYC’s home care services.


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