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:
We’re here to help you continue living independently. If you or a loved one is having trouble with activities of daily living, home safety or personal care, we can provide a specialized program to make life easier and...
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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’re here to help you continue living independently. If you or a loved one is having trouble with activities of daily living, home safety or personal care, we can provide a specialized program to make life easier and...
Life moves in one direction – forward. No matter what each person’s circumstances are, SYNERGY HomeCare steps in with effective, comforting, life-affirming care that moves people, and their loved ones, emotionally and...
In 2019 Susie Murphy started D’Vine Caregivers as a natural extension of her 35 years of excellence in matching nannies and domestic helpers with young families. She now brings her skills and insight in finding and...
LikeFamily Home Care LLC, Compassionate In-Home Care Services At LikeFamily Home Care LLC, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and...
When the time comes that extra care is required, whether due to age or health condition, many people prefer the familiarity and comfort of their own home. At Homewatch CareGivers®, we believe that good care should not...
Serenity Home Healthcare LLC provides compassionate and personalized in-home care services for seniors and individuals with disabilities. Our dedicated caregivers assist with daily activities, medical support, and...
Our team of compassionate and empathetic caregivers is committed to delivering care with a heart! They undergo rigorous training and background checks to ensure they are qualified to provide the care you need. We...
Optimum Senior Care Optimum Senior Care offers in home senior care and caregiver services to the elderly population in the Chicago Metro area. Our mission is to cherish and protect the independence and dignity of our...
“COLLABORATION AND PARTNERSHIP EQUALS EXCELLENT CARE” Excellent Home Health Care, Inc (EHHCI) has been established for the sole purpose of providing individuals and their families with the best possible home health care...
APEX Health Services comprises a team of experts who redefine the continuum of health care model for optimal patient outcomes. We are committed to innovative care models that provide a full spectrum of services evolving...
United Home Care, Inc of Illinois is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Renaissance Home Health Servic is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
St. Rita Home Health Care, Inc is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Health First Home Care, Inc is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Smile & Love Inc proud member of The National Private Duty Association (NPDA) is the nation's first association for providers of private duty home care, which includes non-medical home care services. of National...
Provide-A-Care, Llc is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Marian Healthcare Services, LLC is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Solutions Healthcare, Inc is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Helpers of Greater Chicagoland is the premier provider of in-home senior care. We offer tailored home care services ranging from companion care for seniors who need daily assistance to in-depth specialized care for...
We’re here to help you continue living independently. If you or a loved one is having trouble with activities of daily living, home safety or personal care, we can provide a specialized program to make life easier and...
Private Home Care - Niles, IL is a home care provider that services in Elk Grove Village, IL. 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...
We’re here to help you continue living independently. If you or a loved one is having trouble with activities of daily living, home safety or personal care, we can provide a specialized program to make life easier and...
Life moves in one direction – forward. No matter what each person’s circumstances are, SYNERGY HomeCare steps in with effective, comforting, life-affirming care that moves people, and their loved ones, emotionally and...
In 2019 Susie Murphy started D’Vine Caregivers as a natural extension of her 35 years of excellence in matching nannies and domestic helpers with young families. She now brings her skills and insight in finding and...
LikeFamily Home Care LLC, Compassionate In-Home Care Services At LikeFamily Home Care LLC, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and...
When the time comes that extra care is required, whether due to age or health condition, many people prefer the familiarity and comfort of their own home. At Homewatch CareGivers®, we believe that good care should not...
Serenity Home Healthcare LLC provides compassionate and personalized in-home care services for seniors and individuals with disabilities. Our dedicated caregivers assist with daily activities, medical support, and...
Our team of compassionate and empathetic caregivers is committed to delivering care with a heart! They undergo rigorous training and background checks to ensure they are qualified to provide the care you need. We...
Optimum Senior Care Optimum Senior Care offers in home senior care and caregiver services to the elderly population in the Chicago Metro area. Our mission is to cherish and protect the independence and dignity of our...
“COLLABORATION AND PARTNERSHIP EQUALS EXCELLENT CARE” Excellent Home Health Care, Inc (EHHCI) has been established for the sole purpose of providing individuals and their families with the best possible home health care...
APEX Health Services comprises a team of experts who redefine the continuum of health care model for optimal patient outcomes. We are committed to innovative care models that provide a full spectrum of services evolving...
United Home Care, Inc of Illinois is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Renaissance Home Health Servic is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
St. Rita Home Health Care, Inc is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Health First Home Care, Inc is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Smile & Love Inc proud member of The National Private Duty Association (NPDA) is the nation's first association for providers of private duty home care, which includes non-medical home care services. of National...
Provide-A-Care, Llc is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Marian Healthcare Services, LLC is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Solutions Healthcare, Inc is a home care provider that services in Elk Grove Village, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Helpers of Greater Chicagoland is the premier provider of in-home senior care. We offer tailored home care services ranging from companion care for seniors who need daily assistance to in-depth specialized care for...
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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.