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:
Comfort Keepers of Trophy Club, TX is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Home Instead enables the elderly to live independently. It’s at home where quality of life is enhanced without the stress of interrupted routines and changes in daily habits. Our non-medical CAREGivers provide...
Comfort Keepers of Fort Worth, TX is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Advancal Healthcare Services is a local agency that was built on integrity, love, kindness, and compassion. We are dedicated to being involved in the care of your loved one and fully committed to improving the lives of...
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...
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...
Blessed Home Health Care Inc. has been providing exceptional home care and rehabilitation services since 2018. We are dedicated to delivering compassionate, personalized care tailored to each client’s unique needs. Our...
At Oak Grove Nursing Home and Rehabilitation Center, we believe that where you choose to stay matters. Our dedicated team provides personalized, compassionate care in a comfortable setting, ensuring that each resident's...
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...
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.
When the time comes that extra care is required, whether due to age or health condition, many people prefer the familiarity and comfort of their own home. At Homewatch CareGivers®, we believe that good care should not...
Approved Home Care is known for providing compassionate and personalized in-home care, helping clients maintain their independence and quality of life. Their dedicated caregivers offer a wide range of services, ensuring...
Astral Angels Health Agency 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...
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...
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...
Stephen Conway opened Senior Helpers Fort Worth in 2013 due to his commitment to delivering the best possible in-home care to seniors in the Greater Fort Worth community. After winning a battle with cancer, Steve was...
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...
At Absolute Home Care Services, we are committed to helping you live comfortably and confidently at home. Our dedicated team provides skilled nursing, personal assistance, and therapeutic support—customized to meet your...
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...
Bestcare Home Health Inc is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
"Let us surround your loved one with all the care and compassion they deserve" We are a local, owned home healthcare company that delivers one-on-one personal in home care assistance to Seniors and Disabled...
Healthsouth Tarrant County Home Health is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are committed to providing high quality, client-centered and affordable Home Care services to our clients to assist them to lead dignified and independent lives in the comfort and safety of their own homes. Their...
Quality Home Care can provided exceptional care for your loved ones. Home care allows your elderly parent to stay in their home and receive medical care for a health condition or assistance with daily tasks. Our home...
Southwest Home Health Services is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Professional Caretakers is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Right at Home is an in-home care and assistance agency, providing quality senior and disabled persons care since 1995. We provide trained, insured and bonded caregivers for a variety of caregiving needs. Whether it's for...
Denton Home Health is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
In Home Care is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Abbi Home Care Inc is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Amedisys Home Health of Fort Worth is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Thunder Home Health Services is a locally owned and operated non medical in-home care assistance. Thunder Home health Services is committed to providing cost effective personal care to elderly and disabled persons with...
We are a family-owned home care agency with a mission to change the way the world ages. Our passion for assisting families with loved ones comes from our experiences as family caregivers. We opened our business with a...
Guardian Health Care is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Aiding Home Health Llc is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Finding caregivers who care. Champion Caregivers has been licensed by the State of Texas for over 2 years and provides non-medical companion/ homemaker services to seniors, those recovering from surgery, new and...
Apg Homecare Inc is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ccb Healthcare System is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Medical Case Management Home Health Services is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Doctors Home Healthcare Inc is a home care provider that services in Fort Worth, 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...
We believe in care that serves and supports the whole human person as well as their immediate community. We believe that thoughtful, personalized care has the power to not only maintain but also enrich anyone’s quality of...
Our caregivers and personal assistants help overcome challenges and make home an even better place to be. We include everything from specialty senior care, Alzheimer’s and Dementia care, personal companion services,...
Renew Home Health is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
C & C Caring Hands is proud to provide a high quality level of customer service, medical experience, and commitment to health and wellness to all our patients. Our experienced professionals put your healing needs first....
Comfort Keepers of Trophy Club, TX is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Home Instead enables the elderly to live independently. It’s at home where quality of life is enhanced without the stress of interrupted routines and changes in daily habits. Our non-medical CAREGivers provide...
Comfort Keepers of Fort Worth, TX is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Advancal Healthcare Services is a local agency that was built on integrity, love, kindness, and compassion. We are dedicated to being involved in the care of your loved one and fully committed to improving the lives of...
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...
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...
Blessed Home Health Care Inc. has been providing exceptional home care and rehabilitation services since 2018. We are dedicated to delivering compassionate, personalized care tailored to each client’s unique needs. Our...
At Oak Grove Nursing Home and Rehabilitation Center, we believe that where you choose to stay matters. Our dedicated team provides personalized, compassionate care in a comfortable setting, ensuring that each resident's...
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...
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.
When the time comes that extra care is required, whether due to age or health condition, many people prefer the familiarity and comfort of their own home. At Homewatch CareGivers®, we believe that good care should not...
Approved Home Care is known for providing compassionate and personalized in-home care, helping clients maintain their independence and quality of life. Their dedicated caregivers offer a wide range of services, ensuring...
Astral Angels Health Agency 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...
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...
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...
Stephen Conway opened Senior Helpers Fort Worth in 2013 due to his commitment to delivering the best possible in-home care to seniors in the Greater Fort Worth community. After winning a battle with cancer, Steve was...
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...
At Absolute Home Care Services, we are committed to helping you live comfortably and confidently at home. Our dedicated team provides skilled nursing, personal assistance, and therapeutic support—customized to meet your...
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...
Bestcare Home Health Inc is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
"Let us surround your loved one with all the care and compassion they deserve" We are a local, owned home healthcare company that delivers one-on-one personal in home care assistance to Seniors and Disabled...
Healthsouth Tarrant County Home Health is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are committed to providing high quality, client-centered and affordable Home Care services to our clients to assist them to lead dignified and independent lives in the comfort and safety of their own homes. Their...
Quality Home Care can provided exceptional care for your loved ones. Home care allows your elderly parent to stay in their home and receive medical care for a health condition or assistance with daily tasks. Our home...
Southwest Home Health Services is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Professional Caretakers is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Right at Home is an in-home care and assistance agency, providing quality senior and disabled persons care since 1995. We provide trained, insured and bonded caregivers for a variety of caregiving needs. Whether it's for...
Denton Home Health is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
In Home Care is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Abbi Home Care Inc is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Amedisys Home Health of Fort Worth is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Thunder Home Health Services is a locally owned and operated non medical in-home care assistance. Thunder Home health Services is committed to providing cost effective personal care to elderly and disabled persons with...
We are a family-owned home care agency with a mission to change the way the world ages. Our passion for assisting families with loved ones comes from our experiences as family caregivers. We opened our business with a...
Guardian Health Care is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Aiding Home Health Llc is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Finding caregivers who care. Champion Caregivers has been licensed by the State of Texas for over 2 years and provides non-medical companion/ homemaker services to seniors, those recovering from surgery, new and...
Apg Homecare Inc is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ccb Healthcare System is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Medical Case Management Home Health Services is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Doctors Home Healthcare Inc is a home care provider that services in Fort Worth, 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...
We believe in care that serves and supports the whole human person as well as their immediate community. We believe that thoughtful, personalized care has the power to not only maintain but also enrich anyone’s quality of...
Our caregivers and personal assistants help overcome challenges and make home an even better place to be. We include everything from specialty senior care, Alzheimer’s and Dementia care, personal companion services,...
Renew Home Health is a home care provider that services in Fort Worth, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
C & C Caring Hands is proud to provide a high quality level of customer service, medical experience, and commitment to health and wellness to all our patients. Our experienced professionals put your healing needs first....
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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.