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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.
✔
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:
At Friends and Family Home Care, we understand the importance of comfort and familiarity. That's why we bring professional care right to your doorstep, ensuring your loved ones receive the support they deserve in the...
Home Instead - Simi Valley, Ventura County, CA - Duplicate is a home care provider that services in Camarillo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or...
Home Caregivers Bringing High Quality Care to You While serving our neighbors throughout Southern California, Skilled Home Care Solutions has built a reputation for highly skilled and trustworthy home care services....
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...
Family Ties Home Care was founded by Adam and Cathy Belsky with the mission to provide exceptional levels of care & service for individuals and families requiring in-home care assistance. The husband-and-wife duo believes...
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...
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...
Pacific Coast Homecare Caregivers are passionate about helping older adults live healthy and well in their own homes as they age, improving their quality of life and that of those who love them.
Premier Senior Care is the leading in home senior care provider in California, specializing in Alzheimer's & Dementia Care. It is an established and respected senior care provider offering senior home care, personal...
At Preferred Care at Home of Thousand Oaks, you can expect high-quality and personalized care from our family and our caregivers. Our desire is to help you remain in the comfort and security of your home, or wherever you...
Las Posas Home Health Services is a home care provider that services in Camarillo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Camarillo Skilled Home Health Llc is a home care provider that services in Camarillo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
SJP Care Services LLC is a compassionate in-home care agency dedicated to providing personalized support to individuals in the comfort of their own homes. Their mission is to enhance the quality of life for clients by...
Devoted Care endeavors to elevate our client's quality of living by providing enriching, professional, sincere care and companionship. We do this through caregivers that are devoted to making our clients feel at home and...
We are private duty in - home care agency, providing individualizedcare and supervision at the patients home, assist with Al and taking them to their medical and dental appointments.
Tristar Home Care is made possible by its dedicated team and spearheaded by the efforts of Nico Abad Santos. Nico is a leader with zest, exuberance, and the authenticity needed to run a facility that brings experience and...
All City Caregivers, Inc is a home care provider that services in Camarillo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heritage Care Source LLC is a home care provider that services in Camarillo, CA. 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,...
Our goal is to assist patients in attaining peace of mind and independence, in the comfort of their own residence. We take pride in what we do. We are here to serve you and our community. Darancare has a unique and...
Braewood Home Health Inc is a home care provider that services in Camarillo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
Assisted has been in the Home Health business for over 23 years. We are small enough to be personal, but large enough to provide customized care perfectly matched to yours or your loved one’s needs.
We have a genuine concern for the health and well-being of others and an incredible opportunity to help people live their best lives. By focusing on relationships, we create caring environments where people are encouraged...
All City Caregivers, Inc is a home care provider that services in Camarillo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Senior Helpers Westlake Village, we believe that getting the best care for your loved one should not be complicated. We are fully committed to delivering affordable, high-quality in-home care to seniors in the Orange...
Heart of Angels is a home care provider that services in Camarillo, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At our family-owned Homecare agency, we pride ourselves on providing exceptional, personalized care tailored to each individual's needs. Our compassionate and highly trained caregivers ensure the highest level of service,...
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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.