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, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
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...
Ccor, Inc. is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Always Caring is Always Compassionate Home Care’s Private Pay Division, which offers the highest quality concierge home care services for your loved one. Every one of our patients/clients receives an initial...
Crane Home Care of Rochester, NY is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Chambers Home Care Agency is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Pralid Home Services is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Venture Forthe, Inc. is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Lifetime Care CHHA is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ElderONE, Rochester Regional Health PACE Plan is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Care Plus is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Instead - Rochester, NY - old account is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are a non medical in home care agency for seniors and disabled adults in Monroe County. We have been assisting with activities of daily living for 22 years, making a difference in the lives of families as well as the...
Age brings changes for seniors that make some routine tasks more difficult. Seniors love their homes, but they often need assistance if they want to stay in place. That could mean help preparing meals. Reminders to...
Caring Hearts of Rochester is a Non-Franchise Family Owned and Operated Agency, built on a foundation of core values and dedication to client happiness, quality of life and peace of mind. Our commitment is to service...
Independent Living For Seniors Inc Lthhcp is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Comfort Keepers of Rochester, NY is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Unlimited Care, Inc. is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Care Of Rochester is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Interim Healthcare is a leader in the home care industry with 50 years of experience. We provide supportive services to frail and disabled individuals allowing them to remain independent in their homes. Our care...
Visiting Nurse Signature Care is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Monroe Co. Hlth Dept. Material & Child Hlth Svcs. is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Innovative Care Llc is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Rural/Metro Medical Services is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All American Home Care of Rochester, NY is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At ComForCare of Rochester, our passion for home care is deeply rooted in our own family’s experiences. We have personally witnessed and supported our mothers as they battled Alzheimer’s, Leukemia, and Diabetes. We...
Phi is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Nursecore is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Angels In Your Home of Rochester, NY is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Unity At Home is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Metro Health Care is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Sibley Nursing Personnel Service, Inc. is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Excellent Care LLC is comprised of highly skilled caregivers that specialize in medication management and developing personalized care plans that cover every aspect of our clients needs. We provide daily regimes that...
We improve the lives of our clients by providing compassionate, one-on-one senior care in the comfort of their home. Our reliable caregivers provide home care services 7 days a week from 1 to 24 hours a day.
Family Services Of Rochester, Inc. is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Health Care - Were Here When You Need Us. If you are considering home care services, you are not alone. Its been estimated that more than nine million Americans will utilize some sort of home care service this...
Maxim Of New York, Llc is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Touching Hearts at Home Rochester, NY is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hcr is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
COMPANION Care Of Rochester is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Brookdale West Side Rochester is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Small, private, non-medical home care agency. I am a social worker who has been coordinating services with resources for elderly who wish to stay at home. We give excellent one to one care, whether at home or in assisted...
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...
Let Home Helpers & Direct Link Create a Customized Home Care Plan to Fit Your Lifestyle! Live life your way in the comfort of home with Home Helpers of Rochester! We provide non-medical care for your loved one at home,...
At Griswold Care Pairing for Greater Rochester, NY, we refer compassionate Caregivers to those who want support to live where they love. With over four decades of experience and a storied legacy of compassion and...
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
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...
Ccor, Inc. is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Always Caring is Always Compassionate Home Care’s Private Pay Division, which offers the highest quality concierge home care services for your loved one. Every one of our patients/clients receives an initial...
Crane Home Care of Rochester, NY is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Chambers Home Care Agency is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Pralid Home Services is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Venture Forthe, Inc. is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Lifetime Care CHHA is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ElderONE, Rochester Regional Health PACE Plan is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Care Plus is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Instead - Rochester, NY - old account is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are a non medical in home care agency for seniors and disabled adults in Monroe County. We have been assisting with activities of daily living for 22 years, making a difference in the lives of families as well as the...
Age brings changes for seniors that make some routine tasks more difficult. Seniors love their homes, but they often need assistance if they want to stay in place. That could mean help preparing meals. Reminders to...
Caring Hearts of Rochester is a Non-Franchise Family Owned and Operated Agency, built on a foundation of core values and dedication to client happiness, quality of life and peace of mind. Our commitment is to service...
Independent Living For Seniors Inc Lthhcp is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Comfort Keepers of Rochester, NY is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Unlimited Care, Inc. is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Care Of Rochester is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Interim Healthcare is a leader in the home care industry with 50 years of experience. We provide supportive services to frail and disabled individuals allowing them to remain independent in their homes. Our care...
Visiting Nurse Signature Care is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Monroe Co. Hlth Dept. Material & Child Hlth Svcs. is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Innovative Care Llc is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Rural/Metro Medical Services is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All American Home Care of Rochester, NY is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At ComForCare of Rochester, our passion for home care is deeply rooted in our own family’s experiences. We have personally witnessed and supported our mothers as they battled Alzheimer’s, Leukemia, and Diabetes. We...
Phi is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Nursecore is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Angels In Your Home of Rochester, NY is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Unity At Home is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Metro Health Care is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Sibley Nursing Personnel Service, Inc. is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Excellent Care LLC is comprised of highly skilled caregivers that specialize in medication management and developing personalized care plans that cover every aspect of our clients needs. We provide daily regimes that...
We improve the lives of our clients by providing compassionate, one-on-one senior care in the comfort of their home. Our reliable caregivers provide home care services 7 days a week from 1 to 24 hours a day.
Family Services Of Rochester, Inc. is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Health Care - Were Here When You Need Us. If you are considering home care services, you are not alone. Its been estimated that more than nine million Americans will utilize some sort of home care service this...
Maxim Of New York, Llc is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Touching Hearts at Home Rochester, NY is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hcr is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
COMPANION Care Of Rochester is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Brookdale West Side Rochester is a home care provider that services in Rochester, NY. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Small, private, non-medical home care agency. I am a social worker who has been coordinating services with resources for elderly who wish to stay at home. We give excellent one to one care, whether at home or in assisted...
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...
Let Home Helpers & Direct Link Create a Customized Home Care Plan to Fit Your Lifestyle! Live life your way in the comfort of home with Home Helpers of Rochester! We provide non-medical care for your loved one at home,...
At Griswold Care Pairing for Greater Rochester, NY, we refer compassionate Caregivers to those who want support to live where they love. With over four decades of experience and a storied legacy of compassion and...
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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.