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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
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I consent to the collection of my consumer health data.*
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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:
BlueSea Care is a cutting-edge thought leader in non-medical in-home care for seniors. Our focus is an emphasis on compassion, respect, wellness, and purposeful engagement. Our mission is helping your loved ones stay...
At PCS, we are dedicated to providing compassionate and professional care for you or your loved ones. Our team is extensively trained and committed to enhancing the quality of life of clients by delivering personalized...
SYNERGY HomeCare of Huntington Beach, CA is a home care provider that services in Fountain Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Proudly Serving the Anaheim / Yorba Linda, CA 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...
At Platinum Touch of Care, our mission is to provide unparalleled, compassionate, and personalized care that enhances the quality of life for individuals in need of support. We are dedicated to delivering a platinum...
Home Care Placement is a local, privately owned in-home care, placement, and care management agency. Our mission is to provide a compassionate, world-class customer service experience to our patients and clients. Our...
Premier Senior Care is the leading in home senior care provider in California, specializing in Alzheimer's & Dementia Care. It is an established and respected senior care provider offering senior home care, personal...
In-Home Care Overview: Senior Helpers – Costa Mesa, Newport, Fountain Valley, Santa Ana, Orange CA At Senior Helpers, we are here to help anyway we can -- no matter how big or how small the task.
CARE 1 is a home care provider that services in Fountain Valley, CA. 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...
Senior Helpers - Fountain Valley, CA is a home care provider that services in Fountain Valley, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At H3Assist we know there is no place like home. Familiar surroundings along with friends and family provide the best environment possible. Maintaining independence along with compassionate care makes for a rewarding...
When you or your loved one need help at home, turn to FirstLight Home Care of Irvine. We offer complete companion and personal care services for seniors, new mothers, those recovering from surgery, or anyone who just...
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...
Ease of Mind Hospice is a home care provider serving Tarzana, CA 91356. Our services enable seniors to stay safely in their own homes while receiving medical care or assistance with personal tasks. We offer a range of...
At Friends and Family Home Care, we understand the importance of comfort and familiarity. That's why we bring professional care right to your doorstep, ensuring your loved ones receive the support they deserve in the...
With Koda Caregiver personal care services, we help your relative or loved one with intimate non-medical care needs. Our companion care services provide daily companionship and assistance with daily living activities (ADLs).
At Tandem Careplanning, our mission is to revolutionize home care by empowering seniors and uplifting caregivers, ensuring that together, we thrive. Our CEO, Joshua Greer, faced the same challenges and frustrations as...
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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.