If you're planning to provide care for a family member, friend, or another individual receiving Home Help services, the forms below are required to establish your caregiver enrollment and service agreement. If you have questions about eligibility, caregiver requirements, or the enrollment process, we're here to help. Download and complete each applicable form, then submit it securely using our dropbox below when finished.
Navigate to the Submit Forms tab to see the different methods you can use to complete the forms. Need assistance? Our team is happy to help guide you through the process.
Caregiver Forms
Establishing the Caregiver Relationship (required)
This agreement formalizes the working relationship between the caregiver and care recipient, including authorized services, schedule, and compensation.
Caregiver Intake Form (required)
This form helps Haven Home Care collect important information needed for caregiver enrollment, CHAMPS profile setup, facilitate payroll and administrative processing, and maintain required agency records for compliance, documentation, and audit purposes.
Live-In Caregivers Seeking Exemption from Electronic Visit Verification (EVV) (optional and case-dependent)
This form is used only when a caregiver permanently lives in the same home as the care recipient. Eligible live-in caregivers may qualify for an exemption from EVV requirements. Supporting proof of residency must be submitted with this form for review and approval.