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:
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...
At Lotuscare Services LLC, our mission is to empower and uplift individuals and families through compassionate, client-centered care and support. Based in Lansing, IL, we are dedicated to enhancing the well-being of those...
Acti-Kare of Barrington, IL provides tier one in-home Personal care. Our trained, insured, and bonded caregivers will provide your loved one with in-home personal care services across a broad range of categories. As we...
Entera HomeCare, LLC is a dedicated provider of comprehensive home care services designed to meet the unique needs of individuals in the comfort and familiarity of their homes.
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...
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...
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...
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...
At Homewatch CareGivers of Libertyville, we understand the importance of maintaining independence and comfort in your home. We are committed to providing compassionate and professional in-home care services tailored to...
Our in-home care services brighten the lives of seniors who can benefit from a helping hand and a friendly smile. Our caregivers, who are seniors themselves, make your life easier by providing compassionate care in the...
Ace-Premier Home Care Services, Inc. offers compassionate and personalized in-home care for seniors and individuals with disabilities. Our skilled caregivers provide assistance with daily activities, medical support, and...
Private Home Care - Niles, IL is a home care provider that services in Palatine, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Good Hope Home Health Care, we are dedicated to providing compassionate, professional, and personalized care that enhances the quality of life for those we serve. With a focus on supporting individuals in the comfort...
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...
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...
Resurrection Home Care LLC is a leading provider of in-home care services in the United States. Our mission is to provide compassionate and personalized care to seniors, individuals with disabilities, and those recovering...
COMPASSIONATE & PROFESSIONAL HOME CAREGIVERS If you have a loved one who needs extra care, whether it be due to aging or lifelong challenges, trust the team at Home Helpers® Home Care! We are a professional and...
We are a dedicated healthcare provider committed to delivering exceptional care to those in need. Our goal is to enhance the lives of our patients and their families by providing comfort, support, and dignity.
Govvas Health Care Services, Inc is a home care provider that services in Palatine, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Through our unique system of in-home care that we call Interactive Caregiving™, our Comfort Keepers® engage clients in their care to enhance their independence and well-being. Interactive Caregiving™ includes four...
Call Home Health Care, Inc is a home care provider that services in Palatine, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Optimum Senior Care - Arlington Heights, IL is a home care provider that services in Palatine, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hadukay Care Inc. is a home care provider that services in Palatine, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
CareDiem® Home Care offers the highest quality of care for you and your loved ones. Our goal is to improve the physical, emotional, mental, and spiritual well-being of all our clients.
Healthcare Plus Corporation is a home care provider that services in Palatine, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Healthcare Plus is a home care provider that services in Palatine, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Above & Beyond Care Solutions, Ltd of Inverness, IL is a home care provider that services in Palatine, IL. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At TeamLife Health Group, our services are designed with one goal in mind — to make every day easier, healthier, and more enjoyable for those in our care. We offer an exceptional standard of care, blending expertise 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...
North Shore Compassionate Care is the ideal solution for elderly or disabled individuals who want to maintain their independence and dignity by continuing to live in the comfort of their own homes. Our home health...
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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.