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:
HomeWell Care Services of Plano, TX, is a full service in-home care firm serving the larger North Dallas, TX, area. HomeWell Plano was built by caregivers who cared for their parents before and after joining the in-home...
At Care Mountain, we specialize in elder care at home. We take the time to understand every individual’s unique care needs and develop a personalized multidisciplinary care plan that involves experienced caregivers,...
To provide professional, compassionate and personalized home health care services to our clients that empower individuals to maintain their independence and improve their quality of life. We are committed to delivering...
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...
Sean McLeod, owner of Amada Senior Care in Denton and Frisco, knows through the experiences of loved ones (as both a care provider and a care recipient) that quality care affects not only a patient, but also his or her...
Life moves in one direction – forward. No matter what each person’s circumstances are, SYNERGY HomeCare steps in with effective, comforting, life-affirming care that moves people, and their loved ones, emotionally and...
We understand that home care needs extend beyond the traditional work hours of 9 to 5. That's why our North Dallas team is available 24/7 to address any questions or concerns that you might have. Reach out to us any time...
Life is Better with Villi of Dallas, TX At Villi, we believe “It takes a village,” and we’re here to be that village for you and your loved ones. Our mission is to bring comfort, joy, and a helping hand to your daily...
ParisCare Home Health Agency LLC is a non-medical home care provider dedicated to delivering compassionate and personalized support to individuals who need assistance with daily living activities. Our mission is to...
Amethyst Health Care is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
One You Love Homecare provides senior in-home care services for your loved one. We pride ourselves on being one of the only homecare organizations that delivers what we like to call, “Always Caring Expertise.” Simply put,...
Reliant Home Health is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bledkob Home Health Agency Inc is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
TheKey Corporate - North Dallas, TX is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ovation Home Health Inc. is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Quality Concept Inc is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
SYNERGY HomeCare of Allen, TX is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HomeWell Care Services of Plano, TX, is a full service in-home care firm serving the larger North Dallas, TX, area. HomeWell Plano was built by caregivers who cared for their parents before and after joining the in-home...
PRINCEWILL HEALTHCARE SERVICES INC is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Total Patient Care Home Health is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Abiding Care Services Inc is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Vintage Family Care, LLC is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Newmetric Home Health Care Incorporated is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ENVITAL HEALTHCARE INC is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Mam Unique Health Services Inc is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Treasure Life Healthcare Services Inc is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Peniel Health Care Services Incorporated is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Golden Pond Home Healthcare is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
DEGUARDIAN HEALTH AGENCY INC is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Prestige Health Services is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We Are Comfort Keepers™ Our Family Is Here To Give Comfort To Your Family. Nothing is more important than helping people to live, independent and dignified lives within the comfort of their own homes. Comfort...
Princewill Healthcare Services Inc is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Efe Healthcare Services Inc is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Advant Home Health Services Inc is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Kings Health Care Llc is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
APEX HOME HEALTH CARE AND MANAGEMENT LLC is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Doctors Approved Home Health Inc is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Joab Homehealth Services is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A Place at Home Allen is here to provide you with compassionate professionals to assist you or your loved ones throughout the aging process. We strive to provide seniors with the ability to age with dignity and respect...
Lifeline Healthcare Services Inc is a home care provider that services in Allen, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Shield Home Care offers customized care plans because nobody's situation is the same. Our clients receive specialized consideration that is unique to their needs that aligns with their current issues and lays out a...
There is no higher priority to our NolasHands Family than the safety of our clients and caregivers. We aim to keep all of you out of harm's way and to support you through this challenging time.
Our mission at Home Care Assistance is to change the way the world ages. We provide older adults with quality care in McKinney & Allen and surrounding cities, that enables them to live happier, healthier lives at home....
Jenevieve Homecare provides the upmost quality of care to the person needing homecare. We are driven to help the individual live a quality and dignified life within the comfort of their home and what the individual is...
Comfort Keepers is the leading provider of customized home care services for Carrollton, Coppell, Lewisville, Flower Mound, Farmers Branch, and Addison. Our independently owned and operated Carrollton office provides...
At Griswold Home Care of Plano, our mission is to provide outstanding home care services from outstanding caregivers. Griswold Home Care allows seniors to stay in the home that they love, while maintaining their...
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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.