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:
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ARF is a national provider of home care and staffing services with over 30 years of experience and dedication to enhancing quality of life for others. We are proud of our compassionate home care program designed 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...
Nu Care is the perfect solution for seniors and others in need who are not ready to leave their home for an institutional setting, but need support to remain at home. We improve your life by providing compassionate,...
We are committed to provide unmatched services for the elderly in the comfort of their own home! Since 2011, we have been serving the LA area with the top quality homecare you can find!
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At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
Compassionate Care, Where You Need It Welcome to Dedicated Caregiving LLC, your trusted provider of compassionate and personalized home care services in Reseda, California. At Dedicated Caregiving, we understand the...
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NEST HOME HEALTH, INC. is a home care provider that services in Reseda, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
PRIORITY HOME HEALTH CARE, INC. is a home care provider that services in Reseda, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Celebrity Homecare Inc is a home care provider that services in Reseda, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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 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...
We provide professional, affordable, and caring in-home living assistance for seniors in the Ventura County and Los Angeles County area. We are committed to providing high quality, client-centered and affordable Home Care...
USA Senior Assistants is a company dedicated to provide care and assistance to seniors. Our team of trained experts are dedicated to ensure that your loved ones are properly assisted, and their need are well taken care...
Perfect Fit Home Care is a home care provider that services in Reseda, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
WelbeHealth is a Program of All-Inclusive Care for the Elderly (PACE), full-service healthcare provider that helps you live your life healthy and happy, in your own home.
Founded in 2020 by industry veterans. After 16 years of combined home care nursing experience across different aspects of the home care field, Prestige Home Care Angels' founders decided to start their own home care...
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...
At Interim HealthCare of Chatsworth, we understand how important it is to have someone you can depend on when you or someone you love wants to stay at home to maintain the highest level of health and independence. That's...
Senior Helpers South Valley is a home care provider that services in Reseda, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The Amada Senior Care team in San Fernando Valley is dedicated to going beyond basic home-care by gaining a deep understanding of clients and their individual needs so that they can make a truly positive impact on their...
Home Instead - Winnetka, CA is a home care provider that services in Reseda, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ARF is a national provider of home care and staffing services with over 30 years of experience and dedication to enhancing quality of life for others. We are proud of our compassionate home care program designed 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...
Nu Care is the perfect solution for seniors and others in need who are not ready to leave their home for an institutional setting, but need support to remain at home. We improve your life by providing compassionate,...
We are committed to provide unmatched services for the elderly in the comfort of their own home! Since 2011, we have been serving the LA area with the top quality homecare you can find!
Colon Caregiving Services is a home care provider that services in Reseda, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heritage Home Health, Inc is a home care provider that services in Reseda, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
Compassionate Care, Where You Need It Welcome to Dedicated Caregiving LLC, your trusted provider of compassionate and personalized home care services in Reseda, California. At Dedicated Caregiving, we understand the...
Corinthian Health Care Services, Inc is a home care provider that services in Reseda, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
NEST HOME HEALTH, INC. is a home care provider that services in Reseda, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
PRIORITY HOME HEALTH CARE, INC. is a home care provider that services in Reseda, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Celebrity Homecare Inc is a home care provider that services in Reseda, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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 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...
We provide professional, affordable, and caring in-home living assistance for seniors in the Ventura County and Los Angeles County area. We are committed to providing high quality, client-centered and affordable Home Care...
USA Senior Assistants is a company dedicated to provide care and assistance to seniors. Our team of trained experts are dedicated to ensure that your loved ones are properly assisted, and their need are well taken care...
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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.