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 Friends and Family Home Care, we understand the importance of comfort and familiarity. That's why we bring professional care right to your doorstep, ensuring your loved ones receive the support they deserve in the...
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Abiding Home Care LLC of Laguna Hills, CA proudly provides non-medical home care services to individuals with disabilities, injuries, difficulties with mobility, or illnesses. We are composed of highly trained and...
Assisting Hands is dedicated to providing reliable, compassionate home care that honors the dignity of each of our clients. Our team of highly trained professionals is committed to providing the same level of care we...
Our Mission To provide compassionate, professional home care that empowers individuals to maintain their independence and dignity while giving families peace of mind.
Exceptional Care for Your Loved Ones Our mission is to provide exceptional support to your loved ones in their golden years or those facing well-being challenges. Bella Vie Homecare LLC delivers premier care services...
At Home Helpers® Home Care we offer personal care & companionship care. We assist with elderly care and the basic activities of daily living like hygiene, cooking, mobility, errands and light housekeeping to help your...
At Griswold Home Care for Laguna Hills, we offer compassionate in-home care for those who want support to live where they love. With over four decades of experience and a storied legacy of compassion and integrity, we...
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Alpha Homecare LLC, Compassionate In-Home Care Services At Alpha Homecare LLC, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort, dignity, and independence. Our...
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In-Home Care Overview: Senior Helpers – Costa Mesa, Newport, Fountain Valley, Santa Ana, Orange CA At Senior Helpers, we are here to help anyway we can -- no matter how big or how small the task.
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Being the family caregiver can prove to be a challenge. You may feel burnt out or just overwhelmed trying to manage your own life while helping your loved one. If you are supporting someone through a medical crisis or are...
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At Arosa, we believe in keeping the entire trust circle actively involved in care plan development so we can all make informed choices that are truly in the client’s best interests. Contact us today to learn more about...
CARE NOW HOME CARE SERVICES LLC is a home care provider that services in Irvine, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
After serving in home care for years, Ronel & Rozen Ocampo felt they could offer their BEST CARE for families if they were in charge of their own Caregiver staff and were "hands-on" in their dedication to their family...
Prime Assist Home Care is a company devoted to helping people who need care and companionship. We provide a wide variety of in-home care services which also include all activities of daily living such as grooming, bathing...
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American Homecare, Inc provides premier care for seniors in the comfort and familiarity of their own homes. American Homecare caregivers provide assistance with daily activities of living such as bathing, cooking,...
At Home Personal Care is a home care provider that services in Irvine, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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24 Hour Home Care - Irvine is a home care provider that services in Irvine, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
AllCare Homecare provides compassionate and personalized in-home care services to seniors and individuals requiring supported living services. We prioritize our clients' independence and dignity, and our goal is to help...
Comfort Keepers of Irvine, CA is a home care provider that services in Irvine, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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At Salus, we know there’s no place like home. We also understand that aging presents challenges for the entire family. That’s why Salus was founded: to provide solutions to the complexities aging presents. Our caregiver’s...
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At Lynda's Home Healthcare, we began with a simple idea: to deliver reliable and compassionate in-home care services to those in need. Over the years, we have evolved into a trusted provider of quality personal care...
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LivHOME Orange County is a home care provider that services in Irvine, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
4EVER YOUNG LIVING LLC is a home care provider that services in Irvine, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Safe Guard Care Services, our mission is to provide compassionate, high-quality, and personalized care that enhances the well-being and dignity of every individual we serve. We are dedicated to fostering a safe,...
When you or your loved one need help at home, turn to FirstLight Home Care of Irvine. We offer complete companion and personal care services for seniors, new mothers, those recovering from surgery, or anyone who just...
As a family owned, not for profit organization, Canaan Home Care is at the forefront of the home care industry. Canaan has been a partner of the State of California for over 25 years, together, raising the home care...
Acti- Kare of Irvine provides senior care and home care services in the following locations including Irvine, Newport Beach, University Park, and Northwood in California.
At Golden Years Home Care Solutions Inc – San Diego, our mission is to provide compassionate, personalized, and dependable home care services that empower seniors and individuals with disabilities to live safely,...
At Tandem Careplanning, our mission is to revolutionize home care by empowering seniors and uplifting caregivers, ensuring that together, we thrive. Our CEO, Joshua Greer, faced the same challenges and frustrations as...
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Golden Age Companions is dedicated to improving the lives of seniors and others who have reached the point in life where they need companion care. We’re dedicated to providing personable, hands-on, and integrated caring...
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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.