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.*
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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:
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...
At Emma Home Healthcare of Virginia LLC, our mission is to deliver compassionate, high-quality, and personalized home healthcare services that empower individuals to live safely, independently, and with dignity in the...
Here at Senior Helpers – Virginia Beach, we are a Veteran owned and operated home health care franchise located in Virginia Beach. We provide high quality personal and companion care to individuals in the comfort of their...
Jewish Family Service of Tidewater is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Care with Empathy LLC, we're more than just a home care company- we're your trusted partner in providing compassionate, personalized care. With a dedicated team of experienced caregivers. We understand that each...
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...
CM Health Solutions is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bedrock at Home - Virginia Beach is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Arcadia Health care provides Private Duty Health Care Workers in Virginia Beach, Norfolk, and Chesapeake areas. Arcadia is licensed, bonded, insured, and all workers have at least one year of experience. Complete...
At Ease Home Care is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hope, Care & Love Home Healthcare Services, LLC is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Our vision is to become the leading provider of home care services in Virginia, recognized for our commitment to excellence, compassion, and innovation in care. We aim to empower individuals to age in place with dignity...
Home Helpers Home Care of Virginia Beach, VA is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A & C Alternative Care is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Always Rise Personal Care llc is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Whether providing short-term assistance or long-term support, our team is committed to enhancing well-being and fostering peace of mind for both clients and their families.
At Interim HealthCare, our primary goal is simple. We are dedicated to Improving People's Lives In the Community We Love. As a matter of fact, it’s our mission statement! Proudly operating from five offices serving...
Gentiva Hlth Serv VA Beach is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Atlantic provides a wide range of homecare services including non-medical companion and personal care, as well as, both pediatric and adult private duty nursing. Our professionals partner with our clients and their...
A Taste Of The Kingdom LLC is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cherished Home Services LLC accommodates seniors and dependents needing Skilled Nursing Services and non-medical assistance at home, with the option that most people prefer – to remain independent, comfortable, and safe...
At Embrace Quality Care, we are committed to providing exceptional non-medical home care services. Our focus is on delivering compassionate care with a touch of cheerfulness, ensuring the well-being and happiness of our...
Our Mission Adom Care At Home is committed to providing quality care to the elderly and the sick while they age comfortably in their homes and or recover from Illness and injury.
Cozy Home Care of Virginia is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Gentle Hands Home Healthcare Services is a local Home Healthcare Company specializing in Private Duty, Companionship, and Medicaid Services in the Hampton Roads Area. Since 2008 we have continued to focus on the needs of...
Our mission Our mission is to provide exceptional home care services that empower individuals to live independently while receiving the support necessary to uphold their dignity and quality of life. We are dedicated to...
Faith Journey Home Care LLC is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
CARING 4 YOURS 2 LLC is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Ease Home Care is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Changing Tides Home Care is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caring 4 You is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hope IN-Home Care Inc is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Nothing is more important than helping people to live full, independent and dignified lives within the comfort of their own home. A Caring Hart is dedicated to providing the kind of non-medical in-home care that helps...
our mission is simple yet profound: to provide dependable support and caring service in a family atmosphere. We believe that every individual deserves to age with dignity and independence within the familiar embrace of home.
Beyond Believers LLC is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caring for Your Homecare Services, LLC is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Deloris Home Health in Virginia Beach, Virginia provides comprehensive home health care services to residents in the area. Their offerings include skilled nursing care, physical therapy, occupational therapy, speech...
Home Helpers is a trusted provider of compassionate in home care in over 600 communities across America. We give peace of mind to the families we help by tailoring our in home care services to each situation, and offering...
A Loving Touch Home Care, LLC is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heartland Home Health&hospice is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Above Best Care LLC provides exceptional in-home care services tailored to meet the unique needs of seniors and individuals requiring assistance. Our compassionate caregivers prioritize comfort, safety, and independence,...
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...
Labor of Love Total Healthcare is a Service Disabled, Veteran Owned Small Business (SDVOSB), Small, Women and Minority (SWaM) certified company, established in Virginia in 2006. At Labor of Love we provide more than...
C & R Divine Hands of Care, LLC is a home health care agency based in Virginia Beach, Virginia. Founded in 2015, the company specializes in providing medical and home health solutions, including medical case management...
At FirstLight, we understand your loved one deserves more than having someone who simply keeps them company. They deserve a caregiver who is passionate about helping them have their best day, every day. That’s why we do...
Honesty Home Health, LLC is a home care provider that services in Virginia Beach, VA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Through our unique system of in-home care that we call Interactive Caregiving™, our Comfort Keepers® engage clients in their care to enhance their independence and well-being. Interactive Caregiving™ includes four...
Changing Tides Home Care supports your loved one’s independence and well-being. We work closely with you to develop an individualized care plan, and to match you with caregivers who are well suited to your loved one’s...
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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.