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:
As we age or face an injury, disability, or chronic condition, simple responsibilities around the home and taking care of our physical health can sometimes become too much to handle alone. However, with the right support,...
Noble Care Partners LLC provides compassionate and personalized in-home care services for seniors and individuals with disabilities. Our dedicated caregivers assist with daily living, personal care, and companionship,...
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...
Founded in 1999, we provide much needed respite and personal care, as well as compassion and companionship for the elderly, or those recovering from illness, surgery, or childbirth and the disabled. SYNERGY HomeCare, a...
Maurina Homecare Agency was founded by a Family Nurse Practitioner and a military servicing member. Having worked in the healthcare field, I have witnessed the essence of providing high-standard care in the comfort of...
Bloom Rock Care was founded with a passion for providing high quality in-home care services to seniors and individuals with disabilities. Our founders recognized the need for personalized, compassionate care that is...
Pacesetter Home Services Specializing in Non-Medical In-Home Care Pacesetter Home Services believes in providing competent, affordable, and dependable care. Our staff of well-qualified caregivers are bonded, insured,...
At Aiko Home Care, our mission is to provide exceptional, compassionate, and reliable non-medical in-home care to the residents of Cobb, Douglas, and Paulding counties. We are dedicated to enhancing the quality of life...
Hands of an Angel Homecare, LLC is a home care provider that services in Dallas, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We prioritize dignity, independence, and quality of life, ensuring that every individual receives the best possible care in a safe and supportive environment.
AAO INC is a home care provider that services in Dallas, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Whether providing short-term assistance or long-term support, our team is committed to enhancing well-being and fostering peace of mind for both clients and their families.
Our team of highly skilled professionals offers a range of services, including medical care, personal assistance, and companionship, tailored to meet the unique needs of each client.
At careflix home care services, we offer compassionate, reliable, and professional non-medical home care services to support your loved ones. Our qualified staff assists with daily activities, meal preparation, light...
Pink Hearts Home Care Services, LLC, Compassionate In-Home Care Services At Pink Hearts Home Care Services, LLC, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort,...
Care First LLC is a home care provider that services in Dallas, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Holistique Home Care is a home care provider that services in Dallas, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Angels of Faith Homecare LLC, our mission is to provide compassionate, high-quality, and faith-centered homecare services that nurture the body, uplift the spirit, and preserve the dignity of every individual we serve....
Our team of highly skilled professionals offers a range of services, including medical care, personal assistance, and companionship, tailored to meet the unique needs of each client.
GALAXY HOMECARE & HEALTH SERVICES LLC is a home care provider that services in Dallas, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Purity Home Care provides a full range of affordable services. Our services range from doing your household chores, providing great personal care, friendly companionship and helping you participate in community life. We...
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,...
Acti-Kare is a leading in-home care provider across the United States. For over a decade, our locations have personalized in-home care services around you, your loved one and the family. This allows you or your loved one...
Trinity Health Care Agency is a premier home health care provider dedicated to delivering personalized, compassionate services that enhance the quality of life for individuals in the comfort of their own homes. Our...
JULIA HEALTHCARE STAFFING, LLC is a home care provider that services in Dallas, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
CAREBLOOM HOME HEALTHCARE SERVICES LLC is a home care provider that services in Dallas, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
"At Dawn Flowers Homecare Agency, our mission is to provide compassionate, reliable, and personalized in-home care that enhances the quality of life for every client we serve. We are committed to supporting independence,...
A home care agency provides non-medical assistance to seniors and individuals with disabilities, helping them remain safe and independent in their own homes. Services often include personal care, companionship, light...
NURTURE HEALTHCARE SERVICES LLC is a home care provider that services in Dallas, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
PLECS Homecare is a licensed home health service provider that is dedicated to providing compassionate and excellent homecare services to the elderly and disabled adults. Our services include helping with activities of...
MainSpring Home Care is committed to providing high-quality, affordable, and compassionate Private Home Care Services that meet the needs of our clients and their loved ones in the comfort of their own homes.
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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.