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.*
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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:
Arose Home Care Services LLC, located in Powder Springs, GA, provides compassionate non-medical home care services. They assist individuals with daily living activities, including personal care, meal preparation,...
Our Mission is to give quality care. We have our Nurses and Personal Care Assistants matched for compatibility. Companionship is key to a trusted relationship with our caregivers. With our home health care services, we...
Our focus as a home care agency is to deliver professional care services and staffing solutions for clients of all ages. In every aspect of our profession, we always uphold the value of Excellence in Care as we tend to...
Quality, trust and compassion are the foundations of Southern Crescent Care, LLC. Owned and operated by a registered nurse, our caregivers enhance the lives of seniors across the Atlanta area.
Jojo Home Care Services, Compassionate In-Home Care Services At Jojo Home Care Services, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence....
At Chapman & Friends Healthcare Providers of Georgia, we believe that every individual deserves compassionate and personalized care that is tailored to their unique needs. Our mission is to provide exceptional in-home...
Charlotte Web Private Home Care, LLC is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
With Love Home Care LLC, Compassionate In-Home Care Services At With Love Home Care LLC, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence....
CHI'S is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Divine Healing Healthcare is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our team of highly skilled professionals offers a range of services, including medical care, personal assistance, and companionship, tailored to meet the unique needs of each client
CARING FOR ALL HEALTHCARE SERVICES LLC is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caregivers You Can Trust. Feel better in the comfort of your own home. We specialize providing daily living assistance care to an array of individuals. Whether you need daily or weekly assistance, due to aging,...
providenceHome Care & Convalescent Ministries Inc.Provides Ministry as well as services 24 hours per day 7 days per week~Services are provided in the privacy of your home or facilities I.E. Assisted Living Facilities ,...
HONEST AIDE HOME CARE AGENCY LLC is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Piedmont Homecare Services LLC is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
MILLENNIUM HOME CARE SERVICE is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Suncrest Home Health is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Brittoni HomeCare Services, LLC is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BETTER HEALTH HOMECARE SERVICES is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Olive Healthcare Agency LLC delivers compassionate, personalized in-home care services for seniors and individuals with disabilities. Our skilled caregivers provide assistance with daily activities, medical support, and...
We provide the personal care assistance, companionship, and monitoring that one would receive in a long-term care community while allowing them to remain in the comfort of their own homes.
Home Health of Atlanta is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Compassionate Care for Your Loved Ones At Amazing Grace Health Care Services, we are dedicated to providing personalized and high-quality home health care services for the elderly and disabled. Our mission is to ensure...
DIVINE SOURCE HEALTHCARE SYSTEMS, INC is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
E&E Healthcare Services delivers exceptional in-home care tailored to the unique needs of seniors and individuals with disabilities. Our professional caregivers provide support with daily activities, medical care, and...
PARAGON HEALTHCARE SOLUTIONS LLC is a home care provider that services in Riverdale, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
RAH Heavenly Helping Hands is a trusted provider of non-medical in-home care services in the Riverdale, Georgia area. We are dedicated to enhancing the quality of life for our clients by offering personalized assistance...
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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.