Step 2 Onsite Evaluation SA Input

Please DO NOT submit this form more than once. If you need to change the onsite evaluation time you can do so by checking the email appointment confirmation received from Calendly after the initial scheduling of the onsite evaluation appointment.

The onsite evaluation is an important part of the waiver process which involves an onsite visit at which time we are evaluating if the services we offer fit the needs of the client. During the onsite evaluation, we are also gathering the information we will need to complete an estimate of costs, contacting third parties, assessing necessary logistics and create a plan of action to complete the actual services. The onsite evaluation is just that, an evaluation and no cleaning services are performed during the onsite evaluation. Case managers do not need to attend the evaluation. The written evaluation will be placed into the client portal upon completion. 

In order to fill out this step, step 2, you must have already completed the registration process in step 1 and have been assigned a job ID number by Scene Clean. The onsite evaluation is billed under chore services S5121.

Onsite Evaluation Costs;

Tier 1 is $210.00; Anoka, Hennepin and Ramsey Counties

Tier 2 is $260.00; Carver, Dakota, Scott, Sherburne, Washington, Wright Counties

Tier 3 is $310.00;  Benton, Chisago, Goodhue, Isanti, Kanabec, Meeker, Mille Lacs, Pine, Rice, Stearns Counties

Case by Case costs: You will need to obtain the case by case cost from Scene Clean prior to completion of this form.

 

All missed/no-show evaluations or evaluations cancelled within 24 hrs. will be billed in full. New fees will be required to reschedule.

ATTENTION-MUST READ

Prior to filling out this form have a few dates and times the client is available to schedule the onsite evaluation which is to be done online. Upon completion of this form, you will be taken to the online scheduler. Please DO NOT submit this form again if you are unable to schedule online. Instead, email your POC and ask for a one-time scheduling link.

Onsite Evaluations are scheduled Mondays from 8am-330pm and Fridays from 8am until 230pm in 1 hour arrival windows. 

 DO NOT HIT THE BACK BUTTON UPON SUBMISSION, You will be taken to a confirmation page. If you do not go to a confirmation page your submission did not go through and you will need to re-submit. 

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