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.*
✔
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:
Senior Helpers of Southern Georgia is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Acti-Kare of Albany, GA provides tier one in-home Personal care. Our trained, insured, and bonded caregivers will provide your loved one with in-home personal care services across a broad range of categories.
Your nearest All Ways Caring office is your gateway to all of our quality services, programs and support. Each local office provides the staffing, resources, commitment and experience to ensure that your loved one can...
Welcome to Greater Grace Private Care, your trusted partner in non-medical in-home care throughout Georgia. We are dedicated to providing compassionate and personalized support that enhances the quality of life for our...
NIGHTINGALE SERVICES, INC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
COMPLETE HOME CARE SERVICES is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Everycare Professional Home Health Services LLC, Compassionate In-Home Care Services At Everycare Professional Home Health Services LLC, we are committed to providing high-quality, non-medical in-home care services...
HELPING HANDS CARE INC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Maggiecare Services, INC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ALPHA-1 HOME HEALTH SERVICES, LLC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
1ST CHOICE HEALTH is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heart Home Care of GA, LLC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Phoebe Home Care is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
MSK Home Care Solutions, LLC is a leading provider of compassionate, reliable, and professional home care services dedicated to enhancing the lives of individuals in need of support.
HARRIS PROFESSIONAL CARE is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ravii JMR HOME CARE is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
J R'S LOVING CARE SERVICES is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HEALTHCARE SYSTEMS OF SOUTHERN GEORGIA, INC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Intrepid USA Healthcare Services is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
NEW BIRTH NON-MEDICAL HOMECARE LLC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ENGLEWOOD HEALTH CARE INC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
NIGHTINGALE SERVICES, INC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Assistique' Home Care, We prioritize the well-being and comfort of our clients, we aim to transform the landscape of in-home private care services. Our mission is driven by a deep understanding of the unique...
Senior Helpers of Southern Georgia is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Acti-Kare of Albany, GA provides tier one in-home Personal care. Our trained, insured, and bonded caregivers will provide your loved one with in-home personal care services across a broad range of categories.
Your nearest All Ways Caring office is your gateway to all of our quality services, programs and support. Each local office provides the staffing, resources, commitment and experience to ensure that your loved one can...
Welcome to Greater Grace Private Care, your trusted partner in non-medical in-home care throughout Georgia. We are dedicated to providing compassionate and personalized support that enhances the quality of life for our...
NIGHTINGALE SERVICES, INC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
COMPLETE HOME CARE SERVICES is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Everycare Professional Home Health Services LLC, Compassionate In-Home Care Services At Everycare Professional Home Health Services LLC, we are committed to providing high-quality, non-medical in-home care services...
HELPING HANDS CARE INC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Maggiecare Services, INC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ALPHA-1 HOME HEALTH SERVICES, LLC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
1ST CHOICE HEALTH is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heart Home Care of GA, LLC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Phoebe Home Care is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
MSK Home Care Solutions, LLC is a leading provider of compassionate, reliable, and professional home care services dedicated to enhancing the lives of individuals in need of support.
HARRIS PROFESSIONAL CARE is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ravii JMR HOME CARE is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
J R'S LOVING CARE SERVICES is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HEALTHCARE SYSTEMS OF SOUTHERN GEORGIA, INC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Intrepid USA Healthcare Services is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
NEW BIRTH NON-MEDICAL HOMECARE LLC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ENGLEWOOD HEALTH CARE INC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
NIGHTINGALE SERVICES, INC is a home care provider that services in Albany, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Assistique' Home Care, We prioritize the well-being and comfort of our clients, we aim to transform the landscape of in-home private care services. Our mission is driven by a deep understanding of the unique...
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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.