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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:
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...
Ma Kumba Place LLC is a trusted in-home care agency dedicated to providing compassionate, reliable, and personalized support to individuals who wish to remain in the comfort of their own homes. We specialize in companion...
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...
Heart Matters Home Health Care is dedicated to providing the best possible home care services for you and/or your loved ones. We staff licensed healthcare professionals to assist our clients with activities of daily...
Established to meet the growing needs of families in 1998, Medical Professionals On-Call is a home care service provider servicing Fairfax, Virginia and its’ surrounding areas. As experience home care providers, we offer...
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...
Gloris Health Services LLC is a home care provider that services Herndon, VA 20171. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care and...
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...
Safe and Happy : That is what we all want to be. At Senior Care Safe at Home, our mission is to enable all adults to remain in the most desirable place of all: their own homes. Our goal is to offer the help and...
At FirstLight Home Care, we envision a world in which all adults may age with comfort, dignity and independence in the place they call home. We exist to help people have their best day, every day. Our mission is to...
At SMP Companionship and Care, LLC, we are dedicated to enriching lives in Woodbridge, Virginia, and surrounding areas through compassionate, personalized homecare. Our professional caregivers provide companionship, daily...
More than just a caregiver, we assign each client a care team. Our thoroughly-vetted and qualified caregivers are there to provide care to clients, with the support of a remote Care Team.
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,...
We are a team of dedicated caregivers, nurses, and healthcare professionals passionate about helping individuals live independently and comfortably in their own homes. Our staff is carefully selected, highly trained, and...
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...
When it comes to caring for people who can’t care of themselves, Angels Hands home care agency “Will be there to care for you”, Angels Hands home care agency is for the elderly, children and young people who cannot...
Searching for a like-minded friend to help tackle chores and tasks? Do you seek a companion to join you in hobbies and activities? Our caregivers – seniors themselves – show up ready to exceed expectations – on a schedule...
Our home care is customized for seniors based on their individual needs and preferences. We provide your loved ones with assistance to make it easier for them to complete activities of daily living. We assure you the...
Our Home Health Options Group Inc. (HHO) was formed to provide an aging population and others with diminished physical capabilities with an option to stay at home and receive non-medical assistance. We will provide...
Providing quality in-home care at affordable rates since 1989. Assistance in personal care including help in bathing, showering, dressing, grooming, meal preparation, medication reminders, companionship, transportation to...
At Hope and Recovery Care, we are ready and eager to serve your loved ones with a team of professionals who have expertise in patient care and health recovery. We specialize in nursing care, personal care, and recovery...
At RAKEB HOME HEALTH CARE, LLC, we specialize in providing a comprehensive range of home health care services tailored to meet the unique needs of our clients.
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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.