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:
With over 25 years of experience, Alternate Staffing provides high-quality homecare tailored to patients with physical or mental challenges. Our staff collaborates with you, your family, and your physician to develop an...
Affinity home care is a private concierge agency. We provide a selection of services based on expert-level care for your loved one. As a boutique agency, we are deeply committed to providing exceptional, elevated care...
EPRINE COMMUNITY SERVICES is a premier, licensed healthcare agency that provides dignified and professional mental health and behavioral health services to children, adults, and families, around the states of New York and...
Caregivers You Can Trust Feel better in the comfort of your own home. We specialize in care and daily living assistance to an array of individuals. Whether you need daily or weekly assistance due to aging, illness,...
Today’s Homecare, Inc., is a New York Licensed Home Care Agency providing home health care services in the boroughs of the New York Metropolitan area. Our dedicated, compassionate caregivers provide personalized, services...
Alvita Care is a leading home care provider in New York City, Westchester, Long Island, and New Jersey. We’re best known for in-home senior care, but our caregivers are available to people of all ages, physical...
Graceland Homecare, Inc, Compassionate In-Home Care Services At Graceland Homecare, Inc, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence....
If you need help for just a few hours each day or a couple of times a week, we can visit you in your home and provide as little or as much help as you need, with the aim of helping you to maintain your independence
For over 15 years, Senior Helpers has been serving families across New York City with trusted, dependable in-home care services. From companionship and personal care to highly specialized support, our team is passionate...
LifeWorx is a five-star rated, independently-owned private pay home care agency that brings personalized, compassionate elder care and lifestyle services to the Greater New York area. LifeWorx' Care Consultants are...
The mission of Four Seasons Licensed Home Care Service Agency is to provide comprehensive and coordinated home care to patients with the primary focus on independence at home and preventing hospitalizations.
Many of the seniors St. Nicks Alliance serves require regular assistance with daily activities. St. Nicks Alliance Home Attendants are certified Personal Care Aids (PCAs) who provide assistance with grooming, cooking,...
Touching Hearts at Home of New York City, NY is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Personal Touch Home Aides of New York Inc is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Americare Certified Special Services, Inc CHHA is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bushwick Stuyvesant Heights Home Attendant, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Revival Home Health Care is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Anne Blue Home Health Care Agency, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Excellent Home Care Services LLC is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caring Professionals, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Abundant Life Agency, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Citi Health Home Care Services, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Gentiva Health Services Brooklyn is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
American Biomed Homecare, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Four Seasons Nsg & Rehab Ctr Lthhcp is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
VNA Brooklyn CHHA is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bhrags Home Care Corp. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Best Choice Home Health Care, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Girling Health Care of New York Inc CHHA is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Acare Hhc, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cnh Long Term Home Health Program is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Brooklyn Home Care, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Carewell Home Care, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
City Choice Home Care Services is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Family Care Cert Services of Brooklyn Queens is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
First TO Care Home Care CHHA is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
1St Choice Home Care Services, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alternate Staffing, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Comprehensive Resources, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bluebird Care is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Americare Of New York City is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A Life-Saver Home Care Services, Inc. is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
M J G C Home Care CHHA is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Center For Nursing and Rehabilitation Inc Lthhcp is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bulkan's Healthcare Services is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Lutheran Augustana Center For EC and Rehab Lthhcp is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Comprehensive Home Care is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Galaxy Home Care is a company with deep roots in home health care. Our management team and staff have decades of home health care experience so that we can provide the full range of in-home care services to individuals...
All Care Home Health Services, Llc is a home care provider that services in Brooklyn, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
WHY US? Love and Care LLC offers quality homecare including homemakers, health aides and companions. We screen compassionate and capable caregivers who can play a critical role in delivery of exceptional home health...
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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.