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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:
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...
Life is Better with Villi of Dallas, TX At Villi, we believe “It takes a village,” and we’re here to be that village for you and your loved ones. Our mission is to bring comfort, joy, and a helping hand to your daily...
Stephen Conway opened Senior Helpers Fort Worth in 2013 due to his commitment to delivering the best possible in-home care to seniors in the Greater Fort Worth community. After winning a battle with cancer, Steve was...
Our caregivers deliver high-quality personal care with the sincere intention of preserving a secure and pleasant living environment for their charges. Our care team members take great delight in ensuring that your loved...
Senior Helpers connects caring, professional caregivers with seniors when assistance is needed so they can remain where they are most comfortable. We offer a wide range of personal and companion care services to assist...
At Care Mountain, we specialize in elder care at home. We take the time to understand every individual’s unique care needs and develop a personalized multidisciplinary care plan that involves experienced caregivers,...
At Homewatch CareGivers of Keller Grapevine, we understand the importance of finding a reliable and trustworthy caregiving provider for your loved ones. Whether you’re an elder adult or someone of any age with a health...
At Seniors Helping Seniors - Grapevile, Keller and Denton our in-home care feels less like a service and more like getting a little help from your friends®. Our caregivers are compassionate fellow seniors who are...
BrightStar Care of Fort Worth - Burleson, TX is a home care provider that services in Mansfield, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
GreyMatter Home Care is a family-owned, Christian operated, private home care agency, serving seniors, disabled adults, post-surgery patients, and those that are experiencing temporary disability. Care includes light...
Coe Home Health is a home care provider that services in Mansfield, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ablecare Healthcare Services is a home care provider that services in Mansfield, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Great Faith Senior Care Services LLC is a home care provider that services in Mansfield, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Omega Home Healthcare Agency is a home care provider that services in Mansfield, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Family Care and Comfort is a family owned and operated Senior Care Provider, servicing Tarrant County. Family Care and Comfort takes great pride in hiring only the best caregivers. Our...
DIVINE TOUCH HEALTH SERVICES is a home care provider that services in Mansfield, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At ADF Homecare Services LLC, our mission is to provide exceptional, personalized home care services that enable individuals to live independently and comfortably in their own homes.
Coco Home Care Services LLC is a trusted name in the field of home care, located in the heart of Mansfield, Texas. We are dedicated to enhancing the lives of individuals and families by focusing primarily on providing...
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...
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...
At Home Helpers® Home Care we offer personal care and companionship care. We assist with the basic activities of daily living like hygiene, cooking, mobility, errands and light housekeeping helping your loved one remain...
Star Home Health is a home care provider that services in Mansfield, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Glorious Home Care Services is a home care provider that services in Mansfield, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bebelyn Touch LLC specializes in making sure that you and your loved ones are safe and taken care of in the comfort of your own home. We provide assistance with activities of daily living such as bathing, dressing, meal...
Pancare Homecare Inc is a home care provider that services in Mansfield, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our caregivers and personal assistants help overcome challenges and make home an even better place to be. We include everything from specialty senior care, Alzheimer’s and Dementia care, personal companion services,...
At HomeWell Care Services, we provide hourly at-home care for seniors and others who are struggling to manage day-to-day activities like grooming, bathing, cooking or even running errands. Our knowledgeable Care Managers...
Trusting Arms LLC, TX is a home care provider that services in Mansfield, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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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.