Are you sure you want to exit? Your progress will be lost.
Who are you caring for?
Which best describes their mobility?
How well are they maintaining their hygiene?
How are they managing their medications?
Does their living environment pose any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
Which best describes your loved one's social life?
Acknowledgment of Disclosures and Authorization
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment. You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
✔
I acknowledge and authorize
✔
I consent to the collection of my consumer health data.*
✔
I consent to the sharing of my consumer health data with qualified home care agencies.*
*If I am consenting on behalf of someone else, I have the proper authorization to do so. By clicking Get My Results, you agree to our Privacy Policy. You also consent to receive calls and texts, which may be autodialed, from us and our customer communities. Your consent is not a condition to using our service. Please visit our Terms of Use. for information about our privacy practices.
Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
Remember, this assessment is not a substitute for professional advice.
Share a few details and we will match you to trusted home care in your area:
Giving Hearts Home Care provides assistance with activities of daily living such as bathing, dressing, meal preparation, housekeeping, laundry, med reminders, ambulation, appointment transportation, and other tasks. Our...
When we started LifeWorx in 2004, we wanted to build more than caring, empathetic care services. We wanted to build a community of giving. A place you join as an individual, ‘me’, but where you become part of a greater...
Affinity home care is a private concierge agency. We provide a selection of services based on expert-level care for your loved one. As a boutique agency, we are deeply committed to providing exceptional, elevated care...
Touching Hearts at Home of New York City, NY is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
When we started LifeWorx in 2004, we wanted to build more than caring, empathetic care services. We wanted to build a community of giving. A place you join as an individual, ‘me’, but where you become part of a greater...
LifeWorx is an independently-owned private pay home care agency providing concierge elder care & lifestyle services in your community. Founded 20 years ago, our goal remains the same: to provide the best in-home care and...
7 Day Home Care provides the same level of care that we demand for our own family. We are family-owned and have helped hundreds of clients since our inception. Our compassionate team of skilled professionals develops...
For over 15 years, Senior Helpers has been serving families across New York City with trusted, dependable in-home care services. From companionship and personal care to highly specialized support, our team is passionate...
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Better Helpers, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Smoke Test 052925 is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are dedicated to championing 5 star healthcare for all Americans! Whatever your health and wellness needs are, we are here to help. Stress is known to exasperate health concerns, our dedicated staff, and mobile...
Healthy Care N. Y., Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
TEST TEST Guild health is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Tremont Comm Council Home Attendant Program, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Concerned Home Managers for the Elderly (COHME) is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Fake Test Agency is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Premier Home Health Care Services, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
First Chinese Presbyterian Comm Affairs Hac is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
New York City Department Of Health & Mental Hygien is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Orah Home Health, we believe that every individual deserves care that feels both caring and reliable. Our experienced caregivers provide tailored support—covering daily living activities, emotional companionship, and...
VIPrivate Care is your solution for discreet, premium healthcare on your time. From private duty nurses to round-the-clock medical advice, our team of Registered Nurses, Physical Therapists, Home Health Aids and other...
Our mission is to provide our patients with the best, most trustworthy, and compassionate care within the comfort of their own homes. We thrive to set community standards and exceed our patient’s expectations by providing...
Reliable Community Care, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Barton Home Care, our mission is to enhance the quality of life for individuals and families by providing compassionate, personalized, and professional in-home care services. We are committed to supporting the...
TEST TEST ZH health is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Premier Home Health Care Services Corporate is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Health Management Services, Inc is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
VIPrivate Care - Parent is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Allure Home Care’s companionship services focus on enhancing quality of life by providing emotional support and meaningful engagement. Companions help clients with daily activities such as conversation, games, light...
Harmony Home Care is a premium provider of in-home care services in New York City. We are committed to exceptional client service, and we maintain high standards for our caregivers. We believe caregivers should be kind...
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TheKey Corporate - Mavencare Bronx, NY is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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TheKey Corporate - Mavencare Brooklyn, NY is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Project Ohr (Office For Homecare Referral), Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Jewish Community Council Services Commission, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ny Fndn For Senior Citizens Home Attendant Serv In is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
TM TEST DO NOT USE is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Chinese-American Planning Council Home Attendant is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Advanced Monitored Caregiving, Inc. is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Season Home Attendant is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
SYNERGY HomeCare of New York, NY is a home care provider that services in New York, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
When we started LifeWorx in 2004, we wanted to build more than caring, empathetic care services. We wanted to build a community of giving. A place you join as an individual, ‘me’, but where you become part of a greater...
Sara Companion HomeCare Services is a New York State Licensed Home Care Agency dedicated to providing client and family centered home care services. Our goal is to provide quality continuity of care. Our business...
WHY US? Love and Care LLC offers quality homecare including homemakers, health aides and companions. We screen compassionate and capable caregivers who can play a critical role in delivery of exceptional home health...
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One of our advisors will contact you soon to connect you with trusted sources for care in your area.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.