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:
Home—there’s no place like it. It’s where your memories are. Where you raised your family and where friends have gathered for life’s celebrations. It’s been your basecamp through good times and bad. And it’s where you...
At the heart of our home care agency is a deeply personal journey-caring for our beloved mother following her dementia diagnosis. Through that experience, we came to understand the emotional and physical challenges...
Since 1984, the founders of Preferred Care at Home have had the privilege of assisting clients improve their quality of life while still recognizing and maintaining their dignity and independence. Preferred Care at Home...
PACE of the Southern Piedmont is here to help you continue living in the home and community you love. The Program of All-Inclusive Care (PACE) is a Medicare not for profit, Medicaid State option program. We serve...
Share Care Home Care Services, Compassionate In-Home Care Services At Share Care Home Care Services, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and...
Anjie’s Home Care in Charlotte, NC provides personalized non-medical in-home support for seniors and adults. They offer services such as personal care, meal preparation, companionship, and light housekeeping. Their...
Bright Horizon Home Companion Services LLC, Compassionate In-Home Care Services At Bright Horizon Home Companion Services LLC, we are committed to providing high-quality, non-medical in-home care services that...
We are a senior home care service that allows your loved ones to stay where they feel most comfortable: at their home in West Charlotte or in surrounding areas like Belmont, Stanley, or Bessemer City.
The Synergy HomeCare Difference... Synergy HomeCare, the most trusted name in non-medical in-home care, stands out from the rest because we provide in-home care and services to all ages from senior adults to children....
If you or someone you love needs in-home assistance, contact FirstLight Home Care Greater Charlotte. Whether you’re a senior, a new mother, someone recovering from surgery or you just need extra help, FirstLight Home Care...
HomeWell Care Services of Huntersville, NC serves Charlotte, NC and surrounding areas. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care and...
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...
Life moves in one direction – forward. No matter what each person’s circumstances are, SYNERGY HomeCare steps in with effective, comforting, life-affirming care that moves people, and their loved ones, emotionally and...
Why Affordable Family Care Services? • RN Assessments and Follow up Visits • Caregiver Match • 24-Hour On-Call • Alzheimer’s/Dementia Care Specialists • Licensed-Bonded-Fully Insured • Family Owned and...
BlueDot Cares is a family-owned and operated, in-home care company that provides personalized senior living solutions for people of all ages. BlueDot Cares makes it easy for you or your loved ones to stay safe and...
Autumn Carolina, LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Can Be Safe Home Health Care LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We’re always there when you need us – ready to provide care in all ways. When faced with the decision to provide care, you need a trusted partner. One who has the knowledge gained from years of providing quality home care...
Angel Elite Service, Inc. is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Always 4Ever Young Homecare is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Acti-Kare of Charlotte, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ally Home Care Charlotte, LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bayada Nurses is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Empowering you to live independently at home. If you love your home and plan to stay right where you are, Aldersgate At Home is the perfect solution for seniors. Created by the most respected Life Plan Community in...
Alternative Living Solutions of North Carolina is a Non-Profit outpatient home health company founded by Stephanie Shine-Morrison. We aim to make sure that all of our patients needs are thoroughly taken care of. We offer...
AccordCare -Charlotte, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alexander vaults homecare is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Adorable Caregivers offers personalized in-home care services with a focus on compassion and reliability. Our skilled team assists with daily living activities, ensuring comfort, safety, and independence. Experience...
Angela's Helping Handz inc is a committed community based organization providing dedicated in-home supportive services for our undeserved retired service members, seniors and to our disabled clients who prefer their...
Bayada Nurses - Charlotte is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Since 1975, Bayada Nurses has helped people have a safe home life with comfort, independence, and dignity. Bayada Nurses provides skilled, rehabilitative, therapeutic, and personal home health care services to children,...
Angels by Surprise is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Aroga LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
AADAX HOMECARE INC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Anuera Home Care, LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Who are we 1st Serenity Healthcare Registry is locally operated in the Charlotte metro area. Our team of well qualified healthcare professionals and in partial partnership with Home Care Seminars (one of the oldest...
Abundant Love Home Care Services, LLC provides in-home personal care services in Charlotte, North Carolina, and the surrounding areas. Our assisted living services give any homebound individual the help they need to...
Live in/ Companion/Home Keeper Live-ins can provide the following services: Bedside monitoring for patients in a facility or in the home. Assistance with personal care activities (bathing, grooming, etc. Reminding...
ARS HOME CARE LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Alliance Home Health Services, LLC or Carolina Family Alliance is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or...
Home Helpers Home Care of Lake Norman is more than an in-home health care agency – we’re your extended family when family can’t be there. We’re a locally owned, trusted provider of quality, compassionate in-home care in...
Wisdom Senior Care creates sustainable solutions for our seniors and nurturing them in their daily lives in the comfort of their homes is what we envision.
At One to One Home Care Agency, our mission is to enhance the quality of life for our clients through compassionate, personalized home care services. We are dedicated to providing exceptional, individualized care that...
A New Beginning Community Care LLC is a dedicated and compassionate provider of community-based healthcare services. The organization is committed to delivering high-quality, personalized care to individuals in need,...
Affordable HomeCare was formed by a team of seasoned professionals with a combined experience of more than sixty years, in the field of healthcare.We are dedicated to bringing quality home care services to our clients,...
Senior Helpers Charlotte is the premier provider of in-home senior care. We offer tailored home care services ranging from companion care for seniors who need daily assistance to in-depth specialized care for those with...
Experience a Better Way to Age with Gentle Shepherd Care. Gentle Shepherd Care provides At Home Care services in the Charlotte Metro Area, and Eldercare Management and Lifecare Planning services nationwide. Our support...
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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.