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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.
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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:
Our mission is to provide compassionate, personalized care to individuals who need assistance with daily living activities. We understand that aging, illness, or disability can be challenging, and our goal is to help our...
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Homewatch CareGivers of Woodbridge, VA is a home care provider that services in Lake Ridge, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hallmark Homecare of Prince William, Compassionate In-Home Care Services At Hallmark Homecare of Prince William, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort,...
YOUR PARTNER IN PROFESSIONAL IN-HOME SUPPORTIVE SERVICES At Home Helpers® Home Care in Concord, CA, we are dedicated to providing professional in-home supportive services that help seniors and adults remain safe and...
Executive Home Care in Manassas, VA When you and a loved one in your life require care assistance, Executive Home Care is ready to lend a hand. Find out more about the expert and compassionate senior living care that...
As a licensed home care agency in Virginia, Kind Heart delivers high-quality, personalized care designed to support seniors in living safely and comfortably at home, while also easing the responsibilities of family...
Nestwell Health is your trusted partner in providing exceptional non-medical in-home health services in Dumfries, VA, and surrounding areas. We are committed to enhancing the well-being and quality of life of our clients...
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...
Home Care Solutions Tailored For You Personalized Attention for All Your Health Related Needs If you or your loved ones are facing health problems, temporary or chronic, it may be time to reach out for help. At Indigo...
Green Life Home Care, LLC is a home care provider that services Springfield, VA 22150. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care and...
Beth Tilahun opened the Senior Helpers office of Woodbridge to match the growing need for in-home senior care services in the community. Caregivers at Senior Helpers Woodbridge develop a close, trusting, and professional...
Empowering Independence with Trusted In-Home Care and Companionship Sencura brings compassionate support and trusted companionship to seniors and adults with disabilities. Our reliable, in-home caregiving services are...
Brighter Life Home Health LLC is a locally-owned and operated home-care agency in Virginia, dedicated to supporting individuals in the comfort and familiarity of their own homes. We specialize in both personal care and...
The demand for personal care at home for our elderly loved-ones has increased significantly in recent years. Although most in-home care is still provided by family and friends, many people are challenged when their loved...
Abby’s Home Care Service in Virginia offers dependable, in-home support for individuals facing age-related challenges, health conditions, or disabilities. We help clients remain safe and comfortable in the place they know...
At Obioma Health Care Services, we believe that everyone deserves to experience the comfort and familiarity of home while receiving compassionate and personalized care. With a devoted team of healthcare professionals, we...
At Caring Team LLC, we believe that everyone deserves compassionate, high-quality care in the comfort and familiarity of their home. We are committed to providing exceptional home healthcare services designed to meet the...
Maxbel Home Health Inc. provides Waiver Services to clients at all stages of their lives. Our experts are dedicated to providing care of the utmost quality, consistently advocating for autonomy, respect, and...
Ready 2 Serve Home Healthcare LLC is a locally-operated home health care agency servicing Alexandria, Virginia, and the surrounding counties. We specialize in rendering medical and non-medical care to our patients who are...
Butters Home Health Care is a professional in-home care provider, assisting individuals and families who need one-on-one care of their loved ones. As a team of highly experienced, motivated, and dedicated associates,...
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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.