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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:
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...
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...
LALA Healthcare solutions provides compassionate and personalized in-home care services, ensuring comfort, dignity, and independence for seniors and individuals with disabilities. Our dedicated caregivers offer assistance...
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...
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...
CENC Care Services LLC, is not only our name, but it stands as our way of service. We bring safe, loving, and caring services to those that desire to have a nursing home setting and treatment, in the comfort of their own...
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...
Trusted care means peace of mind. Taking that first step in finding a home care provider can be a stressful decision. With HomeWell Care Services, you know you’re making the right decision.
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...
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,...
Our mission at Home Care Assistance is to change the way the world ages. We provide older adults with quality care that enable them to live happier, healthier lives at home. Our services are distinguished by the caliber...
ComForCare Home Care of Irving, services and compassionate caregivers help older adults live independently in their own homes and continue to do all the things they love. We do not just assign caregivers to a job. We...
Mandate Health Services Llc is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Crest Healthcare Services Inc is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Cosmic Home Healthcare is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Trinity Health and Home Care Services is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Maximacare LLC is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Committed Home Health Care is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Good Hope Healthcare Services LLC is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
CLOSE TO HOME, FAR FROM ORDINARY As a top tier provider of Home Health Care Services in the Dallas/Fort Worth Metroplex and surrounding areas. We understand choosing the company you do business with is very important....
Arc Home Healthcare is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Bright Home Health is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Divine Home Health Care is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Regal Healthcare Inc is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Health Care Plus Inc is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Starcrest Healthcare Services is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BrightStar Care of Frisco & Carrollton, TX is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our mission is rooted in the belief that our clients deserve a life of dignity, with as much independence in the comfort of their own home.All our caregivers are thoroughly screened for caring qualities, skills,...
Passion 05 Health Services Inc is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Golden Heritage Home Health and Hospice Services is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Globalangel Home Health Inc is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A Friendly Home Health Care LLC is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Karing to Care is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Autumn Home Health is a licensed and Medicare certified Home health care agency. We provide services such as: in-home skilled nursing, multi-facetted therapies, homemaking, light house keeping, respite, and personal care....
Careplus Health Services Inc is a home care provider that services in Carrollton, TX. 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...
Skylight Home Health Care Inc is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Care Transitions, LLC is a home care provider that services in Carrollton, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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.
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...
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....
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...
Senior Helpers of Richardson offers companion care, personal care, and chronic disease care to seniors in the Greater Dallas area. We help you to decide what care service is best for your loved one and family 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.