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.*
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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:
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Comfort Home Care LLC, provides in-home care, according to your schedule, your needs, and your individual personality, or that of a loved one for whom you may be primarily responsible. Comfort Home care is unique because...
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'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...
1. A care team led by a Registered Nurse that develops and implements a personalized care plan for each client 2. Experienced, compassionate, and highly trained caregivers 3. On-going training and Development for all...
Welcome to Reliable Care Home Agency, where our commitment to compassionate care is at the forefront of everything we do. We believe that everyone deserves exceptional care and support in their daily activities, and...
Options for Senior America - Gaithersburg, MD is a home care provider that services in Gaithersburg, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Philia is a Home Care Agency in Washington, DC providing senior and child care services. Our focus goes beyond our clients’ safety and health as we incorporate activities into the care plan to address their emotional...
Capital City Nurses CHC- Local/DC is a home care provider that services in Gaithersburg, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Comfi-Kare LLC provides essential home care services in Gaithersburg, MD, supporting seniors with personal care, medication management, companionship, skilled nursing, household help, transportation, respite care, and...
At GLIMS Home Healthcare Services LLC we provide support and assistance in the comfort and familiarity of one's own home for individuals who need help with daily activities due to age, illness, injury, or disability. We...
Senior Helpers Rockville is committed to delivering the best possible in-home care to seniors in Montgomery County. Our top notch caregivers have a passion to serve you or your loved by providing companionship and...
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Premium Home Health Care is owned and operated by true healthcare advocates along with a team of exceptional talents who deeply understand not only what it means to be a caregiver but most importantly, to be a care...
What Makes SYNERGY Different? Reliability SYNERGY HomeCare's Care Team can be relied upon to be at their assigned shift as scheduled. SYNERGY HomeCare utilizes a telephony system allowing us to know when our caregiver...
Life is Better with Villi of Montgomery At Villi, we believe “It takes a village,” and we’re here to be that village for you and your loved ones. Our mission is to bring comfort, joy, and a helping hand to your daily...
At Homewatch CareGivers of Germantown, we offer compassionate and dependable in-home care services designed to support the health, safety, and independence of our clients. As a locally operated franchise location backed...
We believe that people stay healthier, longer by living with liberty and dignity at home, the place they want to be. That philosophy motivates everything we do and embodies our culture and values. Our purpose is to help...
At Homewatch Caregivers of Potomac, we understand that deciding to seek in-home care for a loved one is never easy. It's a choice filled with emotion, hope, and the desire to provide the best for those who have always...
Staffing on the Go was created to solve the complicated nature of hiring quality talent and finding quality jobs in the medical field. Our experienced staff goes through the critical process of verifying every job &...
2nd Family - Eldersburg is a home care provider that services in Gaithersburg, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Nurses On Call - Gaithersburg is a home care provider that services in Gaithersburg, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Care Plus Home Services, Compassionate In-Home Care Services At Care Plus Home Services, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence....
Choosing a reliable Home Health Care Agency is a crucial step to ensuring your family members will have the level of care they deserve. The needs of your family are always in our focus and everything we do is dedicated to...
At Nurturing Angels Home Care of Gaithersburg, we believe that compassionate care begins at home. Our experienced caregivers provide personalized assistance with daily activities, companionship, and specialized support,...
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At Dayspring Support Services, we believe that compassionate care begins at home. Our experienced caregivers provide personalized assistance with daily activities, companionship, and specialized support, ensuring each...
Spring Care LLC, MD is a home care provider that services in Gaithersburg, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our passion at Community Angels Nursing Services is to deliver the highest possible home care and first-class customer service to all without any discrimination. We are passionate about the quality of care we provide, and...
Maryland Home Health Llc is a home care provider that services in Gaithersburg, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Blessing Home Healthcare Services Inc is a home care provider that services in Gaithersburg, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Mbl Associates is a home care provider that services in Gaithersburg, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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One-on-one companionship and daily assistance In-home delivery of Energize 60+ and Brainergize 60+, designed to help prevent or slow down physical and cognitive decline Trained companions who motivate and guide seniors...
VICTORY HOME HEALTH CARE is licensed home Care Agency to provide non medical nursing services . VHHC is a fast growing provider of Home Care Services that enables adolescents and adults to be cared for in their home...
Mercy Grace Home Care Plus, L.L.C. is a home care provider that services in Gaithersburg, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Visiting Angels is America's choice in homecare. We are very well known and respected for the quality of care we provide. We are loved by our clients for our caring, trained, screened and qualified caregivers. We are...
At ITERU Health Care, we believe every client deserves care that listens and responds. Our experienced caregivers provide customized assistance—from daily living support to heartfelt companionship and specialized...
My name is Mirza Donegan and I’m the Director of the Griswold Home Care of Aspen Hill Wheaton here in Maryland. Prior to Griswold Home Care, I was the marketing director at the North Bethesda Transportation Center. I was...
Supporting Services Integration, LLC is a home care provider that services in Gaithersburg, MD. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Care Venture Providers LLC is a home healthcare agency in Gaithersburg, Maryland. Our agency was established to provide skilled and non-skilled care to patients in the comfort of their own homes. This way, we can...
Victory Home Care. Leading Home Health Care In Maryland. Victory Home Care is dedicated to offering in-home care in Maryland. With a clinically focused approach, we are here to provide the best quality care to our...
At Genesis Homecare Services, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence. Our mission is to support individuals in leading fulfilling...
At NN Homehealth Service, we believe that home is the best place for your loved one to receive care. Partnering with families to provide compassionate care for those who matter most. Our goal is to provide our clients...
At Freedom Home Care, we are dedicated to providing the highest quality of care in the Home Care Profession. We are a bonded and insured non-medical home care agency serving the Anne Arundel County Area. We provide...
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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.