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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Maurina Homecare Agency was founded by a Family Nurse Practitioner and a military servicing member. Having worked in the healthcare field, I have witnessed the essence of providing high-standard care in the comfort of...
ASMART HOME CARE SERVICES, INC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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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,...
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COMPLETE NURSING CARE LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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ASSURED & ASSOCIATES PERSONAL CARE OF GA INC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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ELITE CARE HEALTH SERVICES, LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
WELCOME TO PREVAL HOME CARE Private Home Care in Atlanta, Georgia Are you looking for a trusted provider of home care in Atlanta, Georgia? Look no more! We are here to help! Our caregivers ensure that each of our...
At Aiko Home Care, our mission is to provide exceptional, compassionate, and reliable non-medical in-home care to the residents of Cobb, Douglas, and Paulding counties. We are dedicated to enhancing the quality of life...
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Homecare Services All services supervised by a Registered Nurse We understand the needs and desires of our clients. For those who need a little extra care or have chosen to remain at home, versus moving into a...
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We provide tender loving home care services to our clients in the comfort of their own homes. NURSING: We provide total skilled nursing services covering all areas of the human needs. UNSKILLED: We take good care of...
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“A Friend of Your Family” was founded on the belief that our senior friends are to be respected, loved and cared for, not just physically but through a true friendship that is built with someone special. It is our mission...
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Our Complete Care In-Home Care Services staff attendants are passionate about making a difference and are trained to deliver the kind of high-quality care that really makes a difference to the everyday lives of our care...
Our mission at Touch of Kare is to provide a highly dependable and extraordinary healthcare staffing service that respects and protects the dignity and unique needs of our multicultural clients and their families. Our...
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Central Home Health Care, An Amedisys Company is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
CARE FROM THE HEART PRIVATE HOME CARE, LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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SOLIDARITY HOME CARE, LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Amada Senior Care of Atlanta SW, GA is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
CONCORDIA HEALTHCARE SERVICES INC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
VEMANDAL NURSING SERVICES (VNS) IS A STATE OF GEORGIA LICENSED PRIVATE HOME CARE PROVIDER PROVIDING QUALITY SKILLED NURSING SERVICES AND PERSONAL SUPPORT SERVICES TO CLIENTS IN THE COMFORT OF THEIR RESIDENCE. VNS IS...
DIVINE FAVOR HEALTHCARE, LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ULTICARE HEALTH AND HOME CARE AGENCY is a home care provider that services in Douglasville, GA. 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...
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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.