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:
We’re intentionally different. We set the benchmark for excellent home care by balancing our friendly nature, person-centered approach, and discreet services with our love of helping you maintain your independence. It’s...
At Humbly Blessed Personal Services, LLC, we provide dependable, non-medical in-home care designed to enhance quality of life. Our compassionate caregivers are committed to helping individuals maintain independence,...
SYNERGY HomeCare of Northern Indianapolis is owned and operated by Trent Terry, a Master’s graduate in Business Administration who has since put his degree to use in multiple successful entrepreneurial ventures, ranging...
Humble Hearts Home Care provides compassionate, non-medical in-home care designed to support seniors and adults who want to remain safe and comfortable at home.
We’re always there when you need us – ready to provide care in all ways. When faced with the decision to provide care, you need a trusted partner. One who has the knowledge gained from years of providing quality home care...
"A Safe Haven Homecare Services: Your trusted refuge for personalized, compassionate care. Dedicated to enhancing quality of life and providing a safe haven for seniors in the comfort of their own homes."
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,...
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...
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...
Cornerstone Caregiving stands apart in offering compassionate, authentic assistance for your loved ones. We are senior care professionals with 20+ years of experience in the caregiving field who are willing and ready to...
At Prestige Loving Home Care, we are committed to delivering exceptional service to your loved ones. With a dedication to personalized care, we ensure every client experiences comfort and peace in their home and lives an...
Harmony Care Home Care Agency is a compassionate and reliable provider of in-home care services designed to support individuals who wish to maintain their independence and quality of life in the comfort of their own homes.
Abundant Joy Home Care is dedicated to providing compassionate, professional in-home care that supports independence, dignity, and peace of mind. We focus on personalized care solutions designed to meet the unique needs...
At AB Royal Home Care Services Inc, our mission is to provide compassionate, dependable, and personalized in-home care that supports each client’s independence, dignity, and quality of life. We are dedicated to delivering...
FirstLight Home Care of Brownsburg’s in-home care services provide the daily support adults need to live a life of dignity with as much independence as possible in Brownsburg, Avon, Plainfield, Danville and the...
T 3 Home Services is a trusted private pay home care agency in Indianapolis, IN. We assist with ADLs like bathing, dressing, grooming, and mobility, plus IADLs such as meal prep, medication reminders, light housekeeping,...
Let US Make a Difference in your Life. You DESERVE It, Our mission is to bring back the loving, caring, and helping hand that families could always count on — the kind that treats every individual with dignity,...
At Amada Senior Care of Greater Indianapolis, our goal is to walk with seniors and their loved ones through every step of their senior care journey. They are committed to preserving dignity and giving families the peace...
At Hope Group Home Care, our mission is to enhance the lives of individuals living with chronic illnesses in Hendricks County, Hamilton, Boone, Johnson, and surrounding counties.
Mary's Precious Care LLC, Compassionate In-Home Care Services At Mary's Precious Care LLC, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and...
Golden Heart Senior Care offers the highest quality companion care, home care services and personal care services so our clients can live a full and independent life in the comfort of their home.
At Glory Hands Personal Home Care, we offer compassionate and personalized homecare services. Our dedicated team is committed to enhancing the quality of life for those we serve. We hold their hands, you hold their hearts.
WillPower Home Care LLC provides compassionate and personalized in-home care services for seniors and individuals with disabilities. Our dedicated caregivers assist with daily activities, medical support, and...
At Right at Home Indianapolis West, we understand that every journey is unique. Whether you’re here seeking support to live independently, or you’re looking for peace of mind knowing a loved one is in capable hands, our...
At Home is Where The Heart Is Homecare our commitment is to transform the way in-home care is experienced by blending compassion, excellence, and truly personalized support. Our mission is to help individuals live safely...
Locally owned and operated, Senior Helpers Louisville is dedicated to creating a great match between the caregiver and the family. No matter the type of in-home care your loved one requires, trust the team at Senior...
Home Of Connecting Hearts Llc is a licensed Personal Service Agency in the State of IN. Personal Service Agency(s) are licensed individually by city, county, or state governments and surveys are typically completed by...
Care When and Where It’s Needed Our home care services are available 24 hours a day, 7 days a week, 365 days a year, so you know your loved one’s needs are always being met. We offer care when and where it’s needed,...
A & J Home Care LLC provides compassionate and personalized in-home care services for seniors and individuals with disabilities. Our dedicated caregivers assist with daily activities, personal care, and companionship,...
A Peaceful Place Homecare LLC is a home care provider that services in Indianapolis, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A-1 Personal Services Agency in Indianapolis, Indiana, is a licensed, Medicaid-certified home care provider offering personalized non-medical services like personal care, companionship, homemaking, and respite care....
A LOVING WAY HOME CARE SERVICES LLC is a home care provider that services in Indianapolis, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A & R Transportation and Homecare Services is driven by the desire to assist individuals with access to reliable transportation. Our routes include schools, medical appointments, pharmacy, and everyday errands. Our...
A Shining Star LLC is a dedicated service provider focused on delivering exceptional care and support tailored to meet the unique needs of each client. Whether it's in-home care, senior services, or personalized...
A Turning Pointe Home Care LLC aims to foster trust, build meaningful relationships, and empower individuals to thrive. We believe every day is an opportunity to turn the ordinary into something extraordinary.
We support you and your loved ones to live independent and socially active lifestyles, all while building their self-confidence. Many individuals with disabilities (and their caregivers) get overwhelmed when they think...
AAA Home Care Inc. is a home care provider that services in Indianapolis, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
"At A Legacy Of Love Homecare, LLC, we are dedicated to empowering and enriching the lives of our clients by providing exceptional, personalized homecare services in Indianapolis, IN. Our mission is to enhance the quality...
CORNERSTONE CAREGIVING IN INDIANAPOLIS, INDIANA We are a senior home care service that allows your loved ones to stay where they feel most comfortable: at their home in Indianapolis or in surrounding areas like...
Senior Helpers Indianapolis helps families navigate the full continuum of senior care. Our in-home aides allow seniors to receive the day-to-day help with personal care they need and assistance with activities of daily...
Our mission at Yay Bella Homecare Agency is to provide exceptional non-medical in-home care services that promote independence, dignity, and quality of life for our clients. We are dedicated to delivering compassionate...
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...
Our team is dedicated to providing superior care with a focus on safety and respect. We understand how important it is to have confidence in the care your loved one is receiving and we are here to provide that for you.
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...
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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.