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:
At Griswold Home Care of West Houston, we know how hard it can be to care for aging and/or disabled family members. With our assistance, you will not have to do everything alone. With empathy and compassion, our...
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
Herewith, Inc. is a nationwide platform connecting families with caregivers for in-home non-medical assistance. In Texas, they offer flexible senior care services through a network of "Caregivers" who assist with tasks...
Personalized support for families in Sugarland and the Greater Houston area. We bring professional medical-adjacent care and warm companionship directly to your doorstep.
CareCo offers a variety of services to meet each individual client where they need care the most. Our services are designed to supplement family support and medical care, providing comprehensive care coverage to our clients.
St. Anthony Care Services is committed to providing compassionate, reliable, and personalized home care that supports individuals in living safely and comfortably in their own homes. Our trained caregivers offer...
We are a senior home care service that allows your loved ones to stay where they feel most comfortable in Katy, Houston, and surrounding areas. Our trusted Katy staff can’t wait to meet your loved one. We want to know...
Stephen’s Provider Services, LLC provides dependable non-medical in-home care to individuals and families throughout Fort Bend County, Texas. We are committed to delivering high-quality, compassionate support that helps...
Illiana's Angel Healthcare, Compassionate In-Home Care Services At Illiana's Angel Healthcare, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and...
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 Griswold Home Care for Richmond & Rosenberg, serving the Fort Bend County area, we offer compassionate in-home care for those who want support to live where they love. We are an award-winning pioneer in the non-medical...
At Shepherd’s Touch Home Care LLC, we believe compassionate care feels like a guiding hand. Our caring caregivers provide warm, individualized assistance—from daily living support to soothing companionship and...
At Home Instead we have come together as a group of dedicated professionals to deliver an exceptional home care solution that meets your needs. Our trained, screened and bonded CAREGivers serve your family's senior loved...
Anis Healthcare Services Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Kappa Home Health Services Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Davis Home Health LLC is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Promede Home Health Services Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Macy's Health Services Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Livelong Health Care Services Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Asset Health Services Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Med Source Healthcare Services Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Madonna Healthcare Services Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Shiloh First Health Care Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Medinurse Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Comcare Health Services LLC is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Consolidated Home Health is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Gablink Medical Services is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Fortune Home Health Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Sahara Health Care Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Maria Regina Home Health Agency Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
J Rapha Health Services is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Psalm 23 Health Services is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ascon Home Health Services Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Crescent Health Care Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
C & M Health Services is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A Care Home Health Services is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ace Healthcare Services is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Little Flower Homehealth is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Contact Care Health Services Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Serenity Healthcare Services Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cottage Health Care Services Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Rn Home Health Pllc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Jubilee Health Care Inc is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Maximum Care is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Assured Care Health Services LLC is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Healthpoint Home Health and Infusion Services is a home care provider that services in Sugar Land, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We proudly provide non-medical home care services to individuals with disabilities, injuries, difficulties with mobility, or illnesses. We are composed of highly trained and competent staff members who are dedicated and...
Lilly's Home Care specializes in care and daily living assistance to an array of individuals. Whether you need daily or weekly assistance due to aging, illness, recovery, or rehabilitation, our caregivers will provide an...
When we started Modern Vintage, our goal was simple - to improve the overall quality of senior care. We built our business on core values such as communication, reliability and, most importantly, consistent compassionate...
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.