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 Senior Helpers of Lawrenceville, we know how challenging it can be to get the help you or your loved one needs. We have been in the exact same spot as you are in now. Our owners, Debbie and Julio, opened their...
At Carla s Caring Hands Senior Living & Adult Care, we understand the importance of providing high-quality care and support to seniors in need. That’s why we are dedicated to offering round-the-clock assistance to ensure...
Personal Home Care of Atlanta is committed to providing quality, compassionate home care services to our clients while maintaining the highest level of respect and appreciation for them and their family members.
At EMIC HEALTHCARE, we started with a simple idea: to provide reliable and compassionate home health care services to those in need. We are a licensed private home care service agency in Georgia destined to be a trusted...
At Senior 911, we believe that we must provide excellent senior care and that every person we encounter is treated with dignity, kindness, and respect. We provide families with peace of mind that their loved one is safe...
Our in-home care services brighten the lives of seniors who can benefit from a helping hand and a friendly smile. Our caregivers, who are seniors themselves, make your life easier by providing compassionate care in the...
Serenity Care and Compassion is Locally Operated, Licensed, Bonded, Insured, and have been providing compassionate care in Georgia For 15+ Years and are happy to provide services to older adults and children in need of...
Senior Solutions is a non-medical comprehensive home care agency that trains caregivers who assist our clients with activities of daily living in their own homes. In recent years, we have also added service lines to help...
Welcome to Flamede health! We provide efficient, effective, comforting and loving short-term and long-term in-home care. We are here to care for the needs of your loved ones from Pediatric to elderly & disabled. We...
Welcome to SYNERGY HomeCare of Suwanee. Up to 24-hour home care. CARE THAT MOVES YOU. Life moves in one direction – forward. No matter what each person’s circumstances are, SYNERGY HomeCare steps in with...
From delivering specialized home care to managing everyday tasks, or simply keeping your loved one company, we’ll work with you to develop a custom home care plan that compassionately responds to your loved one’s needs,...
Home Instead Snellville offers individualized in-home senior care right in your neighborhood. Our trained, screened and bonded CAREGivers are serving Georgia communities with compassion and devotion.
Charlotte Web Private Home Care, LLC is a home care provider that services in Grayson, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cherish Home Care Solutions is committed to providing compassionate and inclusive care solutions that cater to the diverse needs of individuals, including those with autism. Our mission is to offer specialized support and...
At Graceland Home Care, we understand your home is a place of comfort, security, and cherished memories. Our mission is to provide compassionate and exceptional care right in the heart of your home. With a team of...
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.
Private Home Health Care Are you looking for a competent health care provider that you can trust? ONEKAP is here to provide you with high-quality private home healthcare services. Our professionals are skilled and...
At AidBee Homecare, we provide compassionate, proactive care planning and management, and all care is supervised by nurses to ensure your satisfaction. As a full-service home care agency, we offer a wide range of...
We proudly provide homecare services to seniors, family and individuals with disabilities. Care with great respect, kindness and compassion, being a prime source of dependable health care providers to the community,...
We are a home care agency dedicated to helping clients live an independent, healthy, and happy life through premier concierge services. 365 Elite Home Care is a family owned and privately operated home care agency that...
LANU HEALTHCARE SERVICES LLC is a home care provider that services in Grayson, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Precious Hands Home Care Services is committed to exceed the expectations of our clients by boosting their hope, self-respect, self-confidence and by providing the highest level of care, delivered with grace, compassion,...
Be Well Wellness Company is a home care provider that services in Grayson, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Vision Home Care Service is a home care provider that services in Grayson, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
AFFECTIONATE ANGELS HEALTHCARE is a home care provider that services in Grayson, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Meadow Springs Home Care Agency, our mission is to provide compassionate and personalized home care services to our clients. We strive to improve the quality of life for those we serve, while prioritizing their safety...
Eva and Erma's House - Senior Care Homes is a home care provider that services in Grayson, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Divine Health Care Services is a home care provider that services in Grayson, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At My Place, My Home LLC is a distinguished provider of home-based care services, committed to offering compassionate and personalized care in the comfort and familiarity of your own home. Our focus is on enhancing the...
BRADFORDVILLE SANTEE PROV COMMUNITY HOME CARE, LLC is a home care provider that services in Grayson, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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.