Effective Date: 02/01/2026

This Intake Form Disclaimer is provided to clarify the purpose and limitations of submitting information through the intake form on the Pena Family Care Services LLC website or through any written intake materials.

No Initiation of Services

Submission of an intake form does not initiate home care services, create a contractual relationship, or guarantee the availability of services. Services are provided only after direct communication, assessment of needs, confirmation of availability, and execution of required service agreements.

Non-Medical Services Only

Pena Family Care Services LLC provides private-pay, non-medical home care services only. Information submitted through the intake form is not used to provide medical advice, diagnosis, treatment, or clinical decision-making.

Informational Use of Submitted Data

Information submitted through the intake form is used solely for the purpose of evaluating service requests, communicating with the client or authorized representative, and determining whether services may be appropriate. Submission of information does not obligate either party to proceed with services.

Accuracy of Information

Clients or authorized representatives are responsible for ensuring that all information provided in the intake form is accurate and complete to the best of their knowledge. Pena Family Care Services LLC relies on this information when evaluating potential services.

No Emergency Services

The intake form is not intended for emergency situations. Pena Family Care Services LLC does not provide emergency services. In the event of a medical emergency, call 911 or seek immediate medical assistance.

Privacy and Confidentiality

Information submitted through the intake form is handled in accordance with our Privacy Policy. While reasonable measures are taken to protect information, electronic submissions cannot be guaranteed to be completely secure.

Acknowledgment

By submitting an intake form through this website or in writing, you acknowledge and accept the terms of this Intake Form Disclaimer.

Pena Family Care Services LLC

Private-Pay Non-Medical Home Care

Client Intake Form