PROVIDER-CLIENT SCHEDULE
Client Name	Date
Write the service provided for each day and check all mutually agreed on days that staff see and work with the client. Write in the location where you agree to meet. Write the typical times staff work with the client.
DAY	SERVICE	MUTUALLY AGREED ON	TIMES
DAYS TO MEET	LOCATION
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
I understand that one of my responsibilities in supported living is to meet with staff to work on my goals. I agree to meet with staff on mutually agreeable days and locations. I also understand the days I meet with staff to work may change due to situations such as sickness, doctor appointment, emergencies, beyond my control and beyond the control of staff. I agree that if I am unable to meet with staff at a pre-determined time and/or location that I will notify staff and that staff will also notify me.
Individual	Signature	Date
Client
Guardian
Staff