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.*
✔
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 Cozy Care Home Care, we are dedicated to providing compassionate, personalized, and professional in-home care to seniors and individuals in Columbus, OH, and surrounding areas. Our mission is to ensure that your loved...
Our philosophy at Wise Home Care is to provide the quality of care that we would want for our loved ones. Home care is a sincere appreciation of and for the people we serve. We invite you to call us to discuss how Wise...
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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...
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Lewis Home Care LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Academy Health Services Inc is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
CITYTRANSCARE, LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Good Remedy Home Healthcare, LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ESTHER HOME HEALTHCARE SERVICES LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
American Nursing Care is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HOME CARE, ASSISTED LIVING AND MEDICAL STAFFING IN CENTERVILLE / WARREN COUNTY, OH Empowering People to Live Their Best Lives BrightStar Care® of Centerville / Warren County, OH offers in-home care, assisted living...
Arcadia Home Care & Staffing has been in the business of providing home health care services since 1978 and is a leading provider in the health care service industry. We pride ourselves in being able to understand,...
Home health care provides medical and non-medical services to individuals in their homes, ensuring they receive the necessary care while maintaining independence and comfort. Services include skilled nursing, physical...
Family Home Health Services is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Healing Touch Healthcare, LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
DEBBI HOME HEALTH CARE LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
FirstLight HomeCare of North East Dayton is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Blu Diamond Home Care LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We can help by providing the best home care. We’ll work with you to create a caregiving partnership that’s built on trust, communication, and a special understanding of your family’s needs. And what’s more, we give you...
Our team is dedicated to improving the well-being of our community through serving those who need assistance to live where they love. We are active in the neighborhood, so you’ll see us around town at events,...
Amazing Hands Home Care LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Through our unique system of in-home care that we call Interactive Caregiving™, our Comfort Keepers® engage clients in their care to enhance their independence and well-being. Interactive Caregiving™ includes four...
Beloved Beyond Care is focused on the bottom line which is the individual personal needs and desires. We come along side and Listen while providing exceptional care with over 20 years experience in companionship with a...
Care From The Heart, LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Personal Care Assistance with activities of daily living such as bathing, grooming, dressing, and mobility support.Companion Care Providing companionship and emotional support, including conversation, games, and...
Gem City Home Care is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ComForcare understands that today's busy lifestyles often deprive family members of the time necessary to provide hands on assistance and companionship for their loved ones. Therefore, we want every family we service to...
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ACTIVE is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Countryside Living Elderly Home Care is a family owned business with over 20 years of experience in providing excellent in-home care. Our professional staff have the dedication and reliability needed to provide in-home...
We are a senior home care service that allows your loved ones to stay where they feel most comfortable: at their home in Dayton or in surrounding areas like Kettering, Beaver Creek, or Huber Heights.
CHAMPION LIFE HOMECARE is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Exclusive Home Care Services is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Compassionate Home Health LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Health At Home is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Helping Lives provides compassionate and professional home care for seniors, ensuring safety, comfort, and independence. Our trained caregivers offer personalized assistance with daily activities, medication reminders,...
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Our vision is to provide services, products and education to seniors and their families so aging in place is their first option. Each month we try to highlight our services, share a specific product and help educate...
Buckeye Home Health Care, LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Anderson Senior Care Angels LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bahari Family LLC- is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ADVOCATE HEALTHCARE SERVICES LLC is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A ELEVATED CARE is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Choice Health Care, Ltd is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
HomeWell Care Services of Cincinnati, OH is a home care provider that services in Dayton, OH. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We understand that there is nothing more important than for seniors to live a full, independent and safe life in the comfort of their own homes. Equally important to loved ones and family is the ability to place...
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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.