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:
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...
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...
Healing Haven Home Care stands out from the rest through our unwavering commitment to personalized care and holistic well-being. We take pride in seeing you as a whole person, not just a customer. We believe in treating...
At 1st Touch Home Care, . Our comprehensive home care services are designed to meet the daily needs of older adults while promoting dignity, safety, and peace of mind for both clients and their families. We offer personal...
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...
Seniors Helping Seniors® for the Atlanta Southwest region serves Douglas, Fulton, Coweta, and Cobb counties, offering in-home care and companionship services by matching active, mature caregivers with seniors who need...
At Cornerstone Caregiving, we provide personalized, non-medical in-home care that helps individuals remain safe, independent, and comfortable in the place they call home. Our caregivers are carefully selected and trained...
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,...
Kimberly Cotto, owner of Amada Senior Care in Southwest Atlanta, knows firsthand the impact that accessible healthcare and quality care services can make. As a breast cancer survivor, Kimberly has spent her career...
Home Instead Kennesaw has been providing extensive in-home care services in the Atlanta area for over 15 years. Home Instead can tailor a home care arrangement to fit both your family's lifestyle and budget.
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...
Touch of Kare LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
DIVINE FAVOR HEALTHCARE, LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Graci Grace Home Care, LLC, Compassionate In-Home Care Services At Graci Grace Home Care, LLC, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and...
Changing Lives PHCS, Inc is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ELITE CARE HEALTH SERVICES, LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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.
Ultra Health Care Staffing is a home care provider that services in Douglasville, 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.
Allegiance Home Care, LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ASMART HOME CARE SERVICES, INC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Excel Allied Health Services LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
TRUE CARE PRIVATE CARE ENTERPRISE, LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
As a team of highly experienced, motivated, and dedicated associates, we are committed to the highest standard of service. Our trustworthy care professionals are able to provide you personal care, and homemaking services,...
As you come to get to know us, you will witness our drive and passion for providing assistance and services to seniors that allow them to “age-in-place” in the comfort of their homes. We’re committed to providing families...
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,...
Congenial care partners LLC is a home healthcare agency that is committed to provide the safest relationship-centered care in the local community at an affordable rate. Our trained and fully screened certified nurse...
ASSURED & ASSOCIATES PERSONAL CARE OF GA INC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Breath of TLC Personal Home Care, our motto encapsulates our commitment to providing compassionate, non-skilled services that prioritize your well-being and comfort. We understand that each individual has unique needs,...
PMA GOLDEN CARE LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hearts and Hands Homecare Services, LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Complete Care In Home Care Services our commitment is to transform the way in-home care is experienced by blending compassion, excellence, and truly personalized support. Our mission is to help individuals live safely...
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.
We are a licensed home care agency, serving clients in Georgia and South Carolina. Our mission is to provide high quality, non-medical home care services, utilizing a strength-based approach, to individuals with...
WELCOME TO PREVAL HOME CARE Private Home Care in Atlanta, Georgia Are you looking for a trusted provider of home care in Atlanta, Georgia? Look no more! We are here to help! Our caregivers ensure that each of our...
SOLIDARITY HOME CARE, LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Homecare Services All services supervised by a Registered Nurse We understand the needs and desires of our clients. For those who need a little extra care or have chosen to remain at home, versus moving into a...
BRANDON MEDICAL GROUP, LLC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
CarePlus Home Care LLC is a home care provider that services in Douglasville, 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.
ULTICARE HEALTH AND HOME CARE AGENCY is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
CONCORDIA HEALTHCARE SERVICES INC is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
DRD PRIVATE HOMECARE is a home care provider that services in Douglasville, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our focus as a home care agency is to deliver professional care services and staffing solutions for clients of all ages. In every aspect of our profession, we always uphold the value of Excellence in Care as we tend to...
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...
At Home Matters Caregiving of North Atlanta, we provide homecare that strives to keep our clients as independent as possible; improving quality of life, longevity and provide peace of mind.
FirstLight Home Care delivers loving and compassionate care to seniors in Atlanta in the comfort of their own home. Our team's "Culture of Care" helps people age independently with confidence, dignity and happiness.
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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.