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:
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Kimberly Akers and Kris Patmos are the owners of Amada Senior Care Mesa and longtime friends. Kris says, “We’ve been through many things together, including church ministry, raising our children, and now caring for our...
Home With Help is a trusted provider of comprehensive non-medical companionship / home-making and Personal Care Services in the Greater Scottsdale, Phoenix Arizona. We are committed to providing the most compassionate,...
MD Home Assist, Compassionate In-Home Care Services At MD Home Assist, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence. Our mission is to...
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Assisting Hands Home Care – Gilbert is a home health care agency that provides quality non-medical home care that is tailored to the specific care needs of our clients. Disabilities, illnesses, and aging can make it...
Signal Health Group’s aides, companions, homemakers, and personal care attendants work in the places our clients call home. They are also available as private duty sitters to provide attentive care while you are in the...
Who We Are CORNERSTONE HEALTHCARE INC is an in-home service provider that assists individuals and families. A family and nurse owned agency, We are dedicated to helping our clients lead dignified, independent lifestyles...
Life Light Health is a home care provider that services in Gilbert, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Ahava Healthcare LLC is a home care provider that services in Gilbert, AZ. 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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Home Care Associates, Inc is a home care provider that services in Gilbert, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Grace Home Health Care is a home care provider that services in Gilbert, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Paradise Home Care LLC is a home care provider that services in Gilbert, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Sunset Grand Assisted Living is a home care provider that services in Gilbert, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Caring Senior Service is dedicated to helping seniors remain healthy, happy, and independent in the comfort of their own homes. Since our founding, we have built our reputation on providing reliable, compassionate, and...
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Quality Healthcare In Your Home. We provide professional in-home care services allowing our clients to remain safely and comfortably in their own homes. At Isambulo Home Health care we are dedicated to providing...
At Compassionate Care and Staffing, LLC, we are dedicated to delivering high-quality, compassionate in-home healthcare throughout Arizona. As a trusted home health agency, our mission is to enhance the quality of life for...
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Banner Home Care is a home care provider that services in Gilbert, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Right at Home of Gilbert, AZ is a home care provider that services in Gilbert, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Here at ElderEase we offer a wide range of non-medical services designed to support seniors in maintaining their independence and quality of life at home.
Sunrise Health Services is a home care provider that services in Gilbert, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
SYNERGY HomeCare of the East Valley and Pinal County employs hundreds of caregivers to assist with daily living activities in the comfort of your own home. Let us find the right caregiver to meet your needs. Our...
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...
Golden Heart Senior Care offers the highest quality companion care, home care services and personal care services so our clients can live a full and independent life in the comfort of their home. Golden Heart Senior...
Acti-Kare of Scottsdale, AZ offers in-home care services to Scottsdale and the surrounding areas that will help you or your loved be comfortable at home while you age or rehab at home. Remember, when you can’t be with...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. In select markets we've also added skilled home care for clients that suffer from illness...
At Senior Helpers of Chandler-Gilbert our primary goal is to help provide a high quality of life for our clients and their families, by delivering customized, dependable and affordable care. Our team of highly-qualified...
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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.