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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.
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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.
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We have 3 of them. Yogi is my eldest, then there's Piggy (because of his tail) I couldn't bear to have his little tail docked), and finally there's Spike ( I call him Burro beacuse of his huge ears).
I have severe PTSD (which have resulted in seizures and they think Bi-polar too.And from life experience I know how important an animal (companion) can be. Had it not been for my Yogi (5 yrs ago) I would have done myself in. But he was just a pup when I was left abandoned in the middle of a forest and I HAD to TAKE CARE OF HIM. When all the while unbennounced to me he was keeping me going.
That's how I know how important MOM's little dog is to her. Thank God for creating little creatures with hearts larger then their bodies.
Shar, don't pull your hair out; it will probably fall out soon enough...lol! Mine is graying rapidly. Hope you have some wonderful surprises today, and I'll pray you have blessings as well. What's a Min-Pin? Thanks for lightening our spirits already this morning with your beautiful spirit. Would love to hear more from you...
Dear Shar, I think your wonderful sense of humor will see you through many interesting situations in the days ahead. The present can be precious at times, can't it? But don't pull your hair out
I'm glad you enjoyed my little story. What I failed to mention is that she did this 3 days in a row. I know for a fact that she has the cleanest bath walls in the planet.
As for me...........Well, I try my best and I look at my favorite quote osted at my desk.
"Yesterday is history, tomorrow is a mystery, and today is a gift: that's why they call it the present." Eleanor Roosevelt
Can't wait to see what surprises are in store for me today. There are days I could just pull my hair out. After which I take a long deep breaths and count to 10 just to bring me back. Once I become relaxed I reflect on what it was that made me so upset and most times find myself laughing out loud because whatever she had done was pretty stupid.
Like when she called me via intercom to come and help her little dog, Reynalda (a Chihuahua). I told her I'd be there in a minute or two and then she hung up. This usally means to give her water, food or let her out. So, I took my last gulp or two of coffe and headed over to her house, just 50 yards away. When I arrived I was in a panic, She had leashed her dog and got the leash all wound up between the axleand tire of her mobil chair. Poor little dog was gasping for air and her little eyes were bulging out. I quickly grabbed a kitchen knife and cut the poor little thing loose. And MOM was all the while yelling at her for being too close to her chair. Give me a break!!! She refuses to let the little thing be a dog. It must always be on a leash and must stay on the patio.
We have 2 acres completely fenced and Reynalda loves to play with our herd of little Min-Pins. I finally had to put my foot down and lay the law down on how Reynaldas life was going to be from now on. NO MORE LEASHING or the dog had to go. I think it would kill MOM if she had accidentally killed her little companion. I know that little dog is responsible for MOM's hanging on to some sort of existance.
BTW, Reynalda even without a leash to tangle herself up in, still continues to run in and out from under her mobil chair. I can't win!!
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.
We have 3 of them. Yogi is my eldest, then there's Piggy (because of his tail) I couldn't bear to have his little tail docked), and finally there's Spike ( I call him Burro beacuse of his huge ears).
I have severe PTSD (which have resulted in seizures and they think Bi-polar too.And from life experience I know how important an animal (companion) can be. Had it not been for my Yogi (5 yrs ago) I would have done myself in. But he was just a pup when I was left abandoned in the middle of a forest and I HAD to TAKE CARE OF HIM. When all the while unbennounced to me he was keeping me going.
That's how I know how important MOM's little dog is to her. Thank God for creating little creatures with hearts larger then their bodies.
Shar
Shar, don't pull your hair out; it will probably fall out soon enough...lol! Mine is graying rapidly. Hope you have some wonderful surprises today, and I'll pray you have blessings as well. What's a Min-Pin? Thanks for lightening our spirits already this morning with your beautiful spirit. Would love to hear more from you...
As for me...........Well, I try my best and I look at my favorite quote osted at my desk.
"Yesterday is history, tomorrow is a mystery, and today is a gift: that's why they call it the present." Eleanor Roosevelt
Can't wait to see what surprises are in store for me today. There are days I could just pull my hair out. After which I take a long deep breaths and count to 10 just to bring me back. Once I become relaxed I reflect on what it was that made me so upset and most times find myself laughing out loud because whatever she had done was pretty stupid.
Like when she called me via intercom to come and help her little dog, Reynalda (a Chihuahua). I told her I'd be there in a minute or two and then she hung up. This usally means to give her water, food or let her out. So, I took my last gulp or two of coffe and headed over to her house, just 50 yards away. When I arrived I was in a panic, She had leashed her dog and got the leash all wound up between the axleand tire of her mobil chair. Poor little dog was gasping for air and her little eyes were bulging out. I quickly grabbed a kitchen knife and cut the poor little thing loose. And MOM was all the while yelling at her for being too close to her chair. Give me a break!!! She refuses to let the little thing be a dog. It must always be on a leash and must stay on the patio.
We have 2 acres completely fenced and Reynalda loves to play with our herd of little Min-Pins. I finally had to put my foot down and lay the law down on how Reynaldas life was going to be from now on. NO MORE LEASHING or the dog had to go. I think it would kill MOM if she had accidentally killed her little companion. I know that little dog is responsible for MOM's hanging on to some sort of existance.
BTW, Reynalda even without a leash to tangle herself up in, still continues to run in and out from under her mobil chair. I can't win!!
Shar