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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.
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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:
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.
Merriment Home Care, LLC, located in Jonesboro, GA, is a premier provider of home care services dedicated to offering compassionate and personalized care to individuals in the comfort of their own homes. Our team of...
Thank you for choosing My Healing Angels, your primary source for companion and personal care services. We are dedicated to provide excellent services for all your home care needs. We strive to build personal...
Charlotte Web Private Home Care, LLC is a home care provider that services in Stockbridge, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Palrine Home Care is a trusted provider of personalized in-home care services, committed to helping individuals maintain their independence and quality of life in the comfort of their own homes. With a team of...
At Sync Healthcare Solutions, our mission is to provide innovative, high-quality healthcare services that enhance the well-being and quality of life for our patients. We are dedicated to delivering personalized and...
Serenity Care and Compassion is Locally Operated, Licensed, Bonded, Insured, and have been providing compassionate care in Georgia For 15+ Years and are happy to provide services to older adults and children in need of...
At A Gentle Touch Home Care, our mission is to provide compassionate and personalized support that enhances the quality of life for individuals needing home-based care...
We prioritize dignity, independence, and quality of life, ensuring that every individual receives the best possible care in a safe and supportive environment.
Through carefully-designed services, our team of caregivers assists older adults and children in everyday activities. Our aim is to make their day easier and fulfilling. Our mission is to provide support and excellent...
New Generation Home Care, Inc. is a full service home care agency serving Atlanta and the surrounding communities for over 3 years. WE BRING THE CARE TO YOUR HOME. We accept most major insurances and private pay. Our...
Amicasa Home Care, a metro-Atlanta In-Home Care Agency is Located in Hampton Georgia. We service these metro Atlanta counties: 1. Butts 2. Clayton 3. Dekalb 4. Fayette 5. Fulton 6. Henry 7. Spalding 8. Rockdale Set an...
DIGNITY SENIOR CARE SERVICES, LLC is a home care provider that services in Stockbridge, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
NURSE PRO STAFFING INC is a home care provider that services in Stockbridge, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
GEORGIA GERIATRICS AND REHABILITATION, LLC is a home care provider that services in Stockbridge, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Life moves in one direction – forward. No matter what each person’s circumstances are, SYNERGY HomeCare steps in with effective, comforting, life-affirming care that moves people, and their loved ones, emotionally and...
CARESTAR HEALTHCARE SERVICES LLC is a home care provider that services in Stockbridge, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We aim to deliver quality, compassionate, one-on-one, dependable and cost effective home care services. We ensure families have peace of mind by delivering unmatched reliable care!
Our Agency’s Mission is to provide quality professional and paraprofessional care services to our clients in the comfort of their own homes. We aspire to assist them in achieving their highest potential in performing...
New Generation Health Services, Inc. - Stockbridge, GA is a home care provider that services in Stockbridge, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or...
At Nurse Next Door, we understand the importance of providing top-tier care for your loved ones. That's why our home care services in Henry, GA are overseen by experienced nurse practitioner, ensuring the highest level of...
Miracle Touch Home Care Services LLC is a home care provider that services in Stockbridge, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HOPEFOUND HOME CARE LLC is a home care provider that services in Stockbridge, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BETTER LIFE PRIVATE CARE LLC is a home care provider that services in Stockbridge, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Nuvision Healthcare Service is a home care provider that services in Stockbridge, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
COLEY RELIABLE CARE, LLC is a home care provider that services in Stockbridge, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HomeWell Senior Care provides hourly and 24/7 In-home care for seniors so that they may remain at home indefinitely with the highest level of compassion and always striving toward excellence in all that we do. For...
Shontella's Caring Hearts is a compassionate home care agency dedicated to providing personalized, high-quality care to seniors and individuals with special needs in the comfort of their own homes. Our skilled caregivers...
Clearview Home Care cares about your loved ones as much as you do. Our professional, knowledgeable and friendly caregivers are dedicated to enhancing the quality of life, dignity and independence of your loved ones.
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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.