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.
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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:
The Compassionate Team At On Demand Companion Provides Essential In-Home Support To Seniors Who Cannot Care For Themselves. Our Caregivers Are Committed To Delivering Heartfelt Home Care Services, Offering Non-Medical...
SYNERGY HomeCare of East Columbus - Pickerington, OH is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Home is where the heart is and it provides an unrivaled sense of security, independence, and belonging. We focus on delivering the care and attention needed to preserve and enhance quality of life safely at home with a...
At Hopewell Horizons Home Care, our mission is to provide compassionate, personalized, and professional care that enhances the quality of life for individuals in the comfort and safety of their own homes. We are dedicated...
Seniors Helping Seniors® in-home care services brighten the lives of seniors who can benefit from a helping hand and a friendly smile. Our caregivers, who are seniors themselves, make your life easier by providing...
SOLEO HOME CARE SERVICES Soleo Homecare Services of Columbus, Ohio is dedicated to providing exceptional healthcare staffing solutions tailored to meet the unique needs of homecare environments. Our mission is to deliver...
Eve HomeHealth Care provides compassionate and personalized in-home care services for seniors and individuals with disabilities. Our dedicated caregivers assist wi
Our team at Sympatico Healthcare Solutions is composed of qualified and trained professionals who possess the necessary skills and knowledge in providing holistic care. They are dedicated to helping improve the quality of...
Guardian Angel Health Agency can offer : Assistance with daily activities such as bathing, dressing, grooming, and toileting. Companion Care: Social companionship, conversation, and help with activities like light...
We've been there. We understand. Neither giving nor receiving care is easy. Home Instead® puts relationships first to support those giving care, to protect the dignity of those receiving care, and to enhance the quality...
We offer high-quality care and companionship for seniors and older adults. Our professional and compassionate caregivers help with daily non-medical tasks to ensure a comfortable, dignified and independent life for your...
We are a senior home care service that allows your loved ones to stay where they feel most comfortable: at their home somewhere in Buckeye Nation. We service all of Columbus and its surrounding areas, including Marysville...
At The Wright Choice Healthcare Agency LLC, our mission is to provide exceptional, compassionate, and high-quality healthcare services that empower individuals to live with dignity, independence, and improved well-being....
Ray and Lisa are owners of HomeWell Senior Care of Central Ohio. When they discovered that they could own a business that helped seniors age gracefully and with dignity, they knew this was exactly what they wanted to do!...
Our philosophy at Wise Home Care is to provide the quality of care that we would want for our loved ones. Home care is a sincere appreciation of and for the people we serve. We invite you to call us to discuss how Wise...
ComForcare understands that today's busy lifestyles often deprive family members of the time necessary to provide hands on assistance and companionship for their loved ones. Therefore, we want every family we service to...
We've been there. We understand. Neither giving nor receiving care is easy. Home Instead® puts relationships first to support those giving care, to protect the dignity of those receiving care, and to enhance the quality...
Our Commitment to our clients Let Love Lead Homecare is not your average home care agency. We specialize in innovative and personalized services that provide a peace of mind to those we serve. Our mission is to bring...
Seniors Helping Seniors - Mid-Ohio, OH is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Elegant Home Care Agency, located in Hilliard, Ohio, is a provider of home care services aimed at enhancing the quality of life for individuals who need assistance at home. The agency was established with the goal of...
Covenant Home Health Agency, LLC is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
America's Health Care is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heartland Home Health Care Inc is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Excel Health Services is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Health Care Depo of Ohio, LLC is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Healthpro Home Care is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
City Medical Nursing Svc is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Accessible Home Health Care of Columbus is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Family Healthcare Center, LLC is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bridge of Light Health Services, LLC is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Embrace Home Health Care, LLC is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Best Nursing Care, Inc is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
DL Home Care Solutions is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Affordable Home Health Care Services, LLC is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ebe Healthcare, LLC is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Easton Healthcare Agency, Inc is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Central Ohio Home Help Agency is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Community United, Inc is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Advanced Home Care Inc is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A 1 Nursing Care Inc is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Amandacare, Inc is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Continental Home Health Care, Inc is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Central Ohio Health Care Systems, LLC is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Better Home Care Services, Inc is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Amberstar Home Health LLC is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We've been there. We understand. Neither giving nor receiving care is easy. Home Instead® puts relationships first to support those giving care, to protect the dignity of those receiving care, and to enhance the quality...
Kean Dillon opened the Senior Helpers Columbus office to provide high quality in-home senior care in the community of Westerville and surrounding areas. Senior Helpers strives to treat clients with the same warmth,...
Alta Home Health Care, LLC is a home care provider that services in Columbus, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Helping People through Home Care in Dublin, Ohio - Trusting someone to care for your elderly parent or loved one with disability other than your family, takes a lot of courage and willingness. Turning to FirstLight...
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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.