Phone: 484.674.3760 ext. 105 - E-Mail:



For Care Provider Offices

New Client Instructions (.pdf)

New Client Information Form (.pdf)

FHS HIPAA Authorization to Release Policy Information Form (.pdf)

FHS Assignment of Benefits Form (.pdf)

Bankers Form (.pdf)

CNA Forms (.pdf)

Genworth Forms (.pdf)

John Hancock Forms (.pdf)

MetLife Forms (.pdf)

Penn Treaty Forms(.pdf)

SHIP/AME Forms (.pdf)

For Caregivers

Activity Log Monday – Sunday(.pdf)

Activity Log Sunday – Saturday (.pdf)

Direct Deposit Instructions for Caregivers (.pdf)

FHS Direct Deposit Authorization Agreement (.pdf)


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