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:
Our non-medical in-home care agency provides compassionate support for individuals who need assistance with daily living activities in the comfort of their own homes. We offer personalized services tailored to meet the...
At Cozy Care Home Care, we are dedicated to providing compassionate, personalized, and professional in-home care to seniors and individuals in Columbus, OH, and surrounding areas. Our mission is to ensure that your loved...
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...
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...
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...
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...
We are strong believers in the health of our caregivers as well as our clients. Family Caregivers provide many hours of assistance to their loved ones and that can take an enormous toll. This is called burnout and can...
Because We Know At-Home Care Is Human. People are what makes a house a home. Not stuff. Not chores. Not routines. People. That is why we at Homewatch CareGivers® take what we do far beyond caregiving tasks. Here, home...
Amoureux Health LLC is a healthcare service provider based in Ohio. It specializes in offering personalized and compassionate care, focusing on enhancing the well-being of individuals through high-quality medical and...
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...
At Amada we understand that caring for relatives can be rewarding but also stressful, time consuming and emotionally exhausting. It is difficult for families to juggle work, children and other obligations and still find...
Jana Home Healthcare Services LLC is a home care provider that services in Delaware, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Comfort Keepers of Delaware, OH is a home care provider that services in Delaware, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Interim Healthcare is a leader in the home care industry with 50 years of experience. We provide supportive services to frail and disabled individuals allowing them to remain independent in their homes. Our care...
Our company was founded on the principles of caring for others in a way that we would also want to be cared for which is made evident through our nationwide team of trained professionals who feel called to give care....
At Home Helpers Home Care, we’re here to do exactly what our name says: help. We’re more than an in-home health care agency – we’re your extended family when family can’t be there. From our initial free in-home...
Excel Home Health Plus, Llc is a home care provider that services in Delaware, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
B'ELLA Home Care is a home care provider that services in Delaware, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Sun Home Health Care, Inc is a home care provider that services in Delaware, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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,...
Our non-medical in-home care agency provides compassionate support for individuals who need assistance with daily living activities in the comfort of their own homes. We offer personalized services tailored to meet the...
At Cozy Care Home Care, we are dedicated to providing compassionate, personalized, and professional in-home care to seniors and individuals in Columbus, OH, and surrounding areas. Our mission is to ensure that your loved...
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...
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...
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...
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...
We are strong believers in the health of our caregivers as well as our clients. Family Caregivers provide many hours of assistance to their loved ones and that can take an enormous toll. This is called burnout and can...
Because We Know At-Home Care Is Human. People are what makes a house a home. Not stuff. Not chores. Not routines. People. That is why we at Homewatch CareGivers® take what we do far beyond caregiving tasks. Here, home...
Amoureux Health LLC is a healthcare service provider based in Ohio. It specializes in offering personalized and compassionate care, focusing on enhancing the well-being of individuals through high-quality medical and...
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...
At Amada we understand that caring for relatives can be rewarding but also stressful, time consuming and emotionally exhausting. It is difficult for families to juggle work, children and other obligations and still find...
Jana Home Healthcare Services LLC is a home care provider that services in Delaware, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Comfort Keepers of Delaware, OH is a home care provider that services in Delaware, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Interim Healthcare is a leader in the home care industry with 50 years of experience. We provide supportive services to frail and disabled individuals allowing them to remain independent in their homes. Our care...
Our company was founded on the principles of caring for others in a way that we would also want to be cared for which is made evident through our nationwide team of trained professionals who feel called to give care....
At Home Helpers Home Care, we’re here to do exactly what our name says: help. We’re more than an in-home health care agency – we’re your extended family when family can’t be there. From our initial free in-home...
Excel Home Health Plus, Llc is a home care provider that services in Delaware, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
B'ELLA Home Care is a home care provider that services in Delaware, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Sun Home Health Care, Inc is a home care provider that services in Delaware, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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,...
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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.