Medloc - Nursing In-Demand

1. Your Information

Who is requesting the care?

First Name *

Last Name *

Email *

Phone *

2. Service Address

Where does the nurse need to go?

Street Address *

Apt / Unit / Suite

Province *

City *

Postal Code *

Entry Instructions *

3. Care Details

What kind of care do you need?

Date *

Arrival / Start Time *

End Time *

8.0hours of care

Preferred Language(s)

Describe the Care Needed

Special Needs / Allergies / Mobility Equipment

4. Matching Preference

How would you like to find your care provider?

Either way, you will always review the nurse or PSW's full profile (credentials, ratings, experience) before confirming.

5. Estimated Invoice & Payment Method

Select your payment method. You will not be charged until you accept a matched nurse or PSW.

Payment Protection — You're in Control

Your payment will not be processed when you broadcast your request.
Once a nurse or PSW has accepted your shift, you will be notified immediately.
You will review the matched nurse or PSW's full profile (credentials, ratings, experience).
Only after you accept the match will your payment be processed.
A signed invoice will be emailed to you and MedLoc upon confirmation.

I understand that my payment will not be processed until I have been matched with a nurse or PSW, reviewed their full profile, and accepted the match. Only then will my selected payment method be charged $0.00 (including applicable taxes).

6. Service Contract & Signature

Review and sign below to authorize this care request.

MedLoc At-Home Care Service Agreement

Effective Date: April 14, 2026

Between: MedLoc Nursing On-Demand Inc. (“MedLoc”) and [Client First Name] [Client Last Name] (“Client”)

1. Scope of Service

MedLoc will facilitate the placement of a qualified healthcare provider at the Client's specified address for the duration and date indicated in this agreement. The care provider is an independent contractor matched through the MedLoc platform.

Client Initials:

MedLoc:

ML

2. Service Details

Date: 2026-04-14
Time: 08:00 – 16:00 (8.0 hours)
Location: NB
Provider Type: —
Language Preference: Any

Client Initials:

MedLoc:

ML

3. Fees & Payment

Care Provider Rate: $0.00/hr
MedLoc Service Fee: 15% of care provider pay
Subtotal: $0.00
Applicable Tax (HST 15%): $0.00
Estimated Total: $0.00 (tax included)
Payment is only processed after the Client reviews and accepts a matched care provider
A signed invoice is emailed to the Client and MedLoc upon payment confirmation

Client Initials:

MedLoc:

ML

4. Cancellation Policy

More than 24 hours before shift: Full refund
12–24 hours before shift: 50% refund
Less than 12 hours: No refund (nurse has reserved time)
If no nurse accepts within 24 hours: Automatic full refund

Client Initials:

MedLoc:

ML

5. Client Responsibilities

Provide accurate address and entry instructions
Ensure a safe working environment for the care provider
Inform MedLoc of any known risks, allergies, or special conditions
Do not request services outside the agreed scope

Client Initials:

MedLoc:

ML

6. MedLoc Responsibilities

All care providers are credential-verified and background-checked
MedLoc carries professional liability insurance
24/7 support available for urgent issues

Client Initials:

MedLoc:

ML

7. Limitation of Liability

MedLoc acts as a matching platform. The care provider is an independent contractor. MedLoc is not liable for clinical outcomes but maintains insurance coverage and quality oversight.

Client Initials:

MedLoc:

ML

8. Privacy

All personal and health information is handled in accordance with PIPEDA (Personal Information Protection and Electronic Documents Act) and applicable provincial privacy legislation.

Client Initials:

MedLoc:

ML

Please initial all 8 sections above (at least 2 characters each) before signing.

I have read and agree to the MedLoc At-Home Care Service Agreement above. I authorize MedLoc to broadcast my care request to qualified providers and to charge my selected payment method for $0.00 (including applicable taxes) only after I have reviewed and accepted a matched nurse or PSW. I understand I can cancel per the cancellation policy.

Signature *

Book a Nurse or PSW

1. Your Information

2. Service Address

3. Care Details

4. Matching Preference

5. Estimated Invoice & Payment Method

6. Service Contract & Signature

MedLoc At-Home Care Service Agreement

Book a Nurse or PSW

1. Your Information

2. Service Address

3. Care Details

4. Matching Preference

5. Estimated Invoice & Payment Method

6. Service Contract & Signature

MedLoc At-Home Care Service Agreement