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:
E&M Home Health Care LLC is a trusted provider of home health care services committed to enhancing the well-being and independence of our clients. With a focus on personalized care and attention to detail, we strive to...
We strive to be the extended family when the family can’t be there. Many of us have joined the Home Helpers family because of our own personal experiences with caring for loved ones, and our goal is to provide the same...
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...
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...
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 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...
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 Newark, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Welcome to Family Focus Home Health LLC, your trusted provider of compassionate and personalized home health care services in Newark, Ohio. At Family Focus, we understand the importance of family and believe in treating...
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...
Executive Care, Ltd is a home care provider that services in Newark, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Flint Ridge Village, LLC is a home care provider that services in Newark, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Licking Memorial Hospital Home Care is a home care provider that services in Newark, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Licking County Health Department is a home care provider that services in Newark, 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...
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...
E&M Home Health Care LLC is a trusted provider of home health care services committed to enhancing the well-being and independence of our clients. With a focus on personalized care and attention to detail, we strive to...
We strive to be the extended family when the family can’t be there. Many of us have joined the Home Helpers family because of our own personal experiences with caring for loved ones, and our goal is to provide the same...
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...
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...
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 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...
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 Newark, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Welcome to Family Focus Home Health LLC, your trusted provider of compassionate and personalized home health care services in Newark, Ohio. At Family Focus, we understand the importance of family and believe in treating...
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...
Executive Care, Ltd is a home care provider that services in Newark, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Flint Ridge Village, LLC is a home care provider that services in Newark, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Licking Memorial Hospital Home Care is a home care provider that services in Newark, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Licking County Health Department is a home care provider that services in Newark, 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...
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.