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'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...
Fidelity Home Care is a trusted provider of compassionate, high-quality in-home care services for individuals in need of assistance with daily living activities. With a strong commitment to personalized care, Fidelity...
Amada Senior Care of Bucks and Montgomery County, PA is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Cornerstone Caregiving is a senior home care provider in Greater Philadelphia that is trained and ready to help your loved one today. Our trusted caregivers can start care right away; no deposit or contract is required....
Every Langhorne family faces the challenges of caring for a senior family member differently. No matter the circumstance, the right caregiver can give you and your family respite while helping your loved one enjoy daily...
Local owner David Goodwin opened the Senior Helpers Yardley office to provide the best possible in-home care to seniors throughout the Yardley area. Meet with our team of caring professionals to determine your true needs,...
Our Services. At 5karats of love we provide... In home care Personal care Non skilled care Monitor vital signs accompany doctor appointments Warm companionship Meal preparation Light...
As we strive to offer companionship and holistic support for our clients, Jovial Care Givers works to enhance the quality of life for your loved ones while providing reliable in-home non-medical care in Pennsylvania.
At Prime Health Home Care (PHHC) we started with a basic concept: to provide a family-centered approach to providing quality compassionate care to those in need. PHHC is dedicated to delivering care that not only...
At Homewatch CareGivers, we pride ourselves on being one of the oldest and most trusted providers of customized in-home care services. We know that inviting someone into your home is an important and complex decision,...
LaBensa Home Care Services LLC is a dedicated provider of high-quality, compassionate home care solutions, committed to enhancing the lives of individuals who need support to live independently in the comfort of their own...
GURU HOMECARE, LLC is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Kindest Care Healthcare Llc is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ASSURE HOME CARE, LLC is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Your health and well-being are our first concern! We have been servicing our community for over 7 years, with office staff having more than 22 years combined experience in the home care field. One member of our staff...
PFP SENIOR HOME CARE, INC. is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
RRB HOME HEALTHCARE, LLC is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Concept Services, LLC, is a Home Care Agency. We are Located in Philadelphia Pennsylvania; our mission is to improved the Lives of your love ones. We are here to assist our clients to live more independently with a...
Immediate Homecare Inc is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our Commitment OUR MISSION STATEMENT Hands That Cure, Hearts That Care Our mission is to uphold a client-centric standard of quality health care in the home and care for you like family. We endeavor to maintain the...
Hennetam Home Care LLC is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are here to assist our clients to live more independently with a higher quality of life. Working directly with our clients in creating an individualize care plan. Most importantly we are delivering great passionate...
Dynamic Home Health Care Inc is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ENSURE HOME Care with Angels PA of Andalusia, PA is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We know there’s no place like home. That’s why HomeWell brings you the highest quality of care so you can maintain your independence and experience life to the fullest.
LEONA HEALTHCARE SERVICES LLC is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are a State compliant, registered homecare agency, specializing in assisting seniors and members of the community that require assistance with ADLs. The human condition is dynamic, and key health concerns of today are...
BrightStar Care of Lower Bucks and Southeast Montgomery Counties, PA is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care...
Big Heart PA LLC is a home care provider that services in Bensalem, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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,...
A Tradition of Homecare Excellence Griswold Home Care is a non-medical homecare company. We refer Caregivers who provide personal care, homemaking, meal preparation, companionship, incidental transportation and other...
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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.