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:
BrightStar Care offers a wide variety of high-quality services—from in-home care to medical staffing. If you are looking for a trustworthy care provider or staffing partner in the Midtown Raleigh / Durham, NC area, please...
For more than a decade our C.N.A. and caregiver staff has provided the highest quality home care services: personal care, companion care, fully licensed and insured.
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
Licensed for Hands on Care and Companion Services Fully Insured Licensed by the Department of Health and Human Services Division of Health Services Regulation Covering 14 counties out the Raleigh office: Wake, Alamance,...
Griswold is an award-winning pioneer in the home care industry, with over four decades of experience and a storied legacy of compassion and integrity. We believe Care Professionals are the foundation of our success, and...
Priority Home Care and Home Health is a compassionate and client-centered healthcare service provider dedicated to delivering high-quality, personalized care in the comfort of patients' homes.
Seniors Helping Seniors - Jordan Lake, NC is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
It doesn’t matter if you’re here because you’re looking for help living independently, or if you want to make sure someone you love has the support they need to stay in their home. We believe there’s more to caring for...
Senior Care in Durham, NC is a lifestyle. Our professional team come from the fields of geriatric and nursing care or are nurses, certified nurse assistants, certified nurses and domestic helpers. All are well trained...
Home Instead has been serving Tarheel families for over a decade. We provide the extra help that is sometimes needed so that seniors may continue to live as safely and independently as possible.
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
We are a Professional and Compassionate Leader in Home Care. We specialize in Alzheimer’s, Dementia, Comfort and End Stage of Life Care as well as traditional Home Care and Sitter/Companion Care.
AmeriCare HomeCare provides non-medical home care you can trust and afford. We know that 95% of seniors prefer to remain in the safety, comfort & familiar surroundings of home. Home care can improve quality of life,...
Over the past 12 years Homewatch CareGivers has grown to a company that employs over 170 caregivers and services the entire Triangle area. Over 2,200 Triangle residents have received more than 1.5 million hours of home...
We are a very diverse group of medical and business professionals who have been in the health care and senior care business for many years. We, like many of you, were very frustrated with the lack of a reliable,...
We are committed to providing high quality, client-centered and affordable home care services to our clients to assist them to lead dignified and independent lives in the comfort and safety of their own homes. Their...
We know there’s no place like home. That’s why we bring the highest quality of care right to your front door. With a personalized care management approach and a dedicated team of compassionate caregivers, you can expect...
LIVEWELL Home Care is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
DUPE of Armstrong Care Fairbairn Enterprises L.L.C. is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Our in-home caregiver teams in Chapel Hill come right to your loved one’s home to provide full-time or part-time care. We have the experience necessary to provide your family member with everything he or she needs to be...
As the only Home Care Agency directly associated with a residential care home network, the company is uniquely qualified to offer a broad range of home care services. In particular, most home care agencies offering...
Homewatch CareGivers of Chapel Hill, NC is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Amedisys Home Health of Chapel is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Unc Home Health is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The Best Caregivers! Many home care agencies have good people. The caregivers you get through Acorn are superior for the following reasons: Acorn caregivers are home care professionals who have committed themselves...
One You Love Home Care Chapel Hill NC is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Dynamic Home Healthcare LLC, of North Carolina services includes a wide range of professional health services that can be delivered to the home of a recovering, disabled, or chronically ill person in need of medical,...
BrightStar Care offers a wide variety of high-quality services—from in-home care to medical staffing. If you are looking for a trustworthy care provider or staffing partner in the Midtown Raleigh / Durham, NC area, please...
For more than a decade our C.N.A. and caregiver staff has provided the highest quality home care services: personal care, companion care, fully licensed and insured.
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
Licensed for Hands on Care and Companion Services Fully Insured Licensed by the Department of Health and Human Services Division of Health Services Regulation Covering 14 counties out the Raleigh office: Wake, Alamance,...
Griswold is an award-winning pioneer in the home care industry, with over four decades of experience and a storied legacy of compassion and integrity. We believe Care Professionals are the foundation of our success, and...
Priority Home Care and Home Health is a compassionate and client-centered healthcare service provider dedicated to delivering high-quality, personalized care in the comfort of patients' homes.
Seniors Helping Seniors - Jordan Lake, NC is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
It doesn’t matter if you’re here because you’re looking for help living independently, or if you want to make sure someone you love has the support they need to stay in their home. We believe there’s more to caring for...
Senior Care in Durham, NC is a lifestyle. Our professional team come from the fields of geriatric and nursing care or are nurses, certified nurse assistants, certified nurses and domestic helpers. All are well trained...
Home Instead has been serving Tarheel families for over a decade. We provide the extra help that is sometimes needed so that seniors may continue to live as safely and independently as possible.
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
We are a Professional and Compassionate Leader in Home Care. We specialize in Alzheimer’s, Dementia, Comfort and End Stage of Life Care as well as traditional Home Care and Sitter/Companion Care.
AmeriCare HomeCare provides non-medical home care you can trust and afford. We know that 95% of seniors prefer to remain in the safety, comfort & familiar surroundings of home. Home care can improve quality of life,...
Over the past 12 years Homewatch CareGivers has grown to a company that employs over 170 caregivers and services the entire Triangle area. Over 2,200 Triangle residents have received more than 1.5 million hours of home...
We are a very diverse group of medical and business professionals who have been in the health care and senior care business for many years. We, like many of you, were very frustrated with the lack of a reliable,...
We are committed to providing high quality, client-centered and affordable home care services to our clients to assist them to lead dignified and independent lives in the comfort and safety of their own homes. Their...
We know there’s no place like home. That’s why we bring the highest quality of care right to your front door. With a personalized care management approach and a dedicated team of compassionate caregivers, you can expect...
LIVEWELL Home Care is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
DUPE of Armstrong Care Fairbairn Enterprises L.L.C. is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Our in-home caregiver teams in Chapel Hill come right to your loved one’s home to provide full-time or part-time care. We have the experience necessary to provide your family member with everything he or she needs to be...
As the only Home Care Agency directly associated with a residential care home network, the company is uniquely qualified to offer a broad range of home care services. In particular, most home care agencies offering...
Homewatch CareGivers of Chapel Hill, NC is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Amedisys Home Health of Chapel is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Unc Home Health is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The Best Caregivers! Many home care agencies have good people. The caregivers you get through Acorn are superior for the following reasons: Acorn caregivers are home care professionals who have committed themselves...
One You Love Home Care Chapel Hill NC is a home care provider that services in Chapel Hill, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Dynamic Home Healthcare LLC, of North Carolina services includes a wide range of professional health services that can be delivered to the home of a recovering, disabled, or chronically ill person in need of medical,...
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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.