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:
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...
Always Family provides quality elder care solutions that serve all of your loved one’s care needs. Our mission is to make the care experience easier for families by managing the entire process right from the very...
Our caregivers deliver high-quality personal care with the sincere intention of preserving a secure and pleasant living environment for their charges. Our care team members take great delight in ensuring that your loved...
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 Happier At Home - DFW, our mission is to provide compassionate and personalized home care services that empower individuals to maintain independence, dignity, and quality of life in the comfort of their own homes. We...
Senior Helpers - Irving, TX is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cornerstone Caregiving stands apart in offering compassionate, authentic assistance for your loved ones. We are senior care professionals with 20+ years of experience in the caregiving field who are willing and ready to...
Comfort Oak Health, located in Arlington, TX, is a dedicated non-medical in-home care agency focused on providing compassionate and personalized support to individuals and families. We offer a range of services including...
HomeWell Care Services of Ft. Worth, TX is a home care provider that services Fort Worth, TX 76115. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our mission at Ambience In-Home Care is to ensure seniors maintain happy and healthy lives in the golden years. We provide older adults with high-quality home care in Richardson that enables them to continue living at...
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...
Stephen Conway opened Senior Helpers Fort Worth in 2013 due to his commitment to delivering the best possible in-home care to seniors in the Greater Fort Worth community. After winning a battle with cancer, Steve was...
When the time comes that extra care is required, whether due to age or health condition, many people prefer the familiarity and comfort of their own home. At Homewatch CareGivers®, we believe that good care should not...
At Homewatch CareGivers of Keller Grapevine, we understand the importance of finding a reliable and trustworthy caregiving provider for your loved ones. Whether you’re an elder adult or someone of any age with a health...
Home Care Book is a home care provider in Dallas-Fort Worth TX founded by professionals with national experience in healthcare. After reviewing countless home care and healthcare delivery models, Home Care Book was...
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,...
Ganix Home Health Care Services Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
All Care Professional Home Health Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Naaman Primary Home Health Care Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Amenite Home Health Agency is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Classic Home Care is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Gilead Community Home Health Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bridgeway Health Services Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Abundant Home Health LLC is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Prudential Health Care Services Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Barclays Home Healthcare Services Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Thhhci Tender Hands Home Health Care Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Scof Healthcare Providers is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Lipet Home Care Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Estelles Home Health Agency Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ariel Amana Healthcare Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Harriet Home Health Care Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Rosas First Quality Home Healthcare LLC is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Tender Heart Home Health LLC is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Florence Health Care Services & Training Center IN is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Emmanuel Healthcare Services is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
St. Nicholas Healthcare Agency is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Care For All Home Health is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Guardian Angels at Home Care Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Fountains Home Health Care Inc is a home care provider that services in Arlington, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At HomeWell Care Services, we provide hourly at-home care for seniors and others who are struggling to manage day-to-day activities like grooming, bathing, cooking or even running errands. Our knowledgeable Care Managers...
At A&T Moore Health Care, we know that although needs change, dignity remains important. That’s why we offer superior home care from compassionate and qualified caregivers.
Our caregivers and personal assistants help overcome challenges and make home an even better place to be. We include everything from specialty senior care, Alzheimer’s and Dementia care, personal companion services,...
SYNERGY HomeCare of Fort Worth serves over 2,200 square miles, in more than 38 zip codes in the surrounding areas of Fort Worth, Aledo, Benbrook, Burleson, Cleburne, Granbury, Glen Rose, Mansfield, Mineral Wells,...
AccuAid Care Services provides companion care, personal care, respite care, and dementia care wherever older adults need it. Whether you or your loved one needs help due to injury, illness, or age related decline, we are...
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.
C & C Caring Hands is proud to provide a high quality level of customer service, medical experience, and commitment to health and wellness to all our patients. Our experienced professionals put your healing needs first....
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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.