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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:
Discover Hallmark Homecare, your premier referral agency connecting you with top-tier independent, professional caregivers for a direct-hire experience. Embrace our mission: Empowering seniors to lead fulfilling and...
Our story is deeply personal—it’s shaped by our own experiences. A few years ago, we faced the difficult journey of caring for Jeorgia’s mother when her health began to decline. As her needs grew beyond what we could...
HomeWell Care Services provides 24-Hour care, hourly personal care, companionship, and homemaker services for our clients so they may remain in the comfort of their own homes. Our staff of skilled and dedicated caregivers...
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...
Right at Home Lewisville believes there is far more to caring for people than simply providing in-home assistance. You deserve a care partner who understands the journey ahead and will help you navigate every step....
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
ComForCare Home Care of Irving, services and compassionate caregivers help older adults live independently in their own homes and continue to do all the things they love. We do not just assign caregivers to a job. We...
Preferred Care at Home of North Austin and Williamson County is locally owned and operated, providing caregiving services including companionship, medication reminders, hygiene assistance, light housekeeping, meal...
We are a senior home care service that allows your loved ones to stay where they feel most comfortable: at their home in Keller or in surrounding areas like Watauga or North Richland Hills.
Assisting Hands Home Care® grew out of a desire to provide seniors, and others needing non-medical assistance at home, with the option that most people prefer – to remain independent, safe and comfortable in their own...
Griswold Home Care of Fort Worth and Southlake is proud to be backed by a national franchise brand with over 40 years of experience. Griswold is a pioneer in the home care industry and continues to set the standard for...
Our experienced and professional caregivers provide the care and support you or your loved one need to remain living independently at home while providing peace of mind to the family caregiver.
Life is Better with Villi of Dallas, TX At Villi, we believe “It takes a village,” and we’re here to be that village for you and your loved ones. Our mission is to bring comfort, joy, and a helping hand to your daily...
Professional Home Health Care Inc is a home care provider that services in Euless, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are a Family owned business that genuinely cares for your Family members like our own. We have been serving the DFW Metroplex area for several years and continue to build relationships with past and present clients....
Novus Cura Healthcare PC is a home care provider that services in Euless, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Novel Home Health Agency is a home care provider that services in Euless, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Steward Home Healthcare Inc is a home care provider that services in Euless, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cardinal Home Health Care is a home care provider that services in Euless, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Lima Care Agency provides personalized senior care to make life easier and more enjoyable for seniors. Services are tailored to individual care needs after an in-home assessment, offering scheduling flexibility and...
Empowering Independence, Enriching Lives: Dasa Home Care Agency is committed to providing compassionate and professional home care services tailored to meet the unique needs of each individual. Our mission is to enhance...
Right at Home - Euless, TX is a home care provider that services in Euless, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Angels At Hand Health Care is a home care provider that services in Euless, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At HomeWell Care Services, we provide hourly at-home care for seniors and others who are struggling to manage day-to-day activities like grooming, bathing, cooking or even running errands. Our knowledgeable Care Managers...
Comfort Keepers provides uplifting home care across Tarrant County! We offer customized plans for families, and a variety of services. While we focus on personal care, incontinence care and companionship, we assist with...
AccuAid Care Services provides companion care, personal care, respite care, and dementia care wherever older adults need it. Whether you or your loved one needs help due to injury, illness, or age related decline, we are...
At Homewatch CareGivers of Keller Grapevine, we understand the importance of finding a reliable and trustworthy caregiving provider for your loved ones. Whether you’re an elder adult or someone of any age with a health...
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...
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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.