Create Service Agreement

Select Services

Service Type *

Service Description *

Please provide detailed information about the care requirements

Select Preferred Nurse *

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Schedule & Pricing

Start Date *

End Date *

Preferred Days *

Preferred Start Time *

Preferred End Time *

Billing Frequency *

Billing Rate ($) *

$

Auto-Renew Agreement

Automatically renew this agreement when it expires

Cancellation Notice (Days) *

Number of days notice required before cancellation

Review Terms

Agreement Terms

Generating agreement terms...

Special Instructions (Optional)

HIPAA Authorization *

I authorize the sharing of my protected health information with the assigned nurse and NoidNurse platform for the purpose of providing care services as outlined in this agreement.

Terms of Service *

I have read and agree to the Terms of Service and understand my rights and obligations under this service agreement.

Data Sharing Consent *

I consent to the collection, processing, and sharing of my data as described in the Privacy Policy for the purpose of service delivery and platform improvement.

Sign Agreement

Electronic Signature Disclosure

By providing your electronic signature below, you agree that it has the same legal force and effect as a handwritten signature. You acknowledge that you have the right to request a paper copy of this agreement and that your consent to electronic signatures is voluntary.

Electronic Signature Consent *

I consent to use electronic signatures for this agreement and understand that my electronic signature is legally binding.

Signature Method *

Draw Your Signature

Draw your signature using mouse or touch

Signature Date