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:
Heavenly Touch, LLC is a dedicated home care agency committed to providing compassionate, non-medical support to individuals in the comfort of their own homes. Our skilled caregivers assist with daily living activities,...
Why Affordable Family Care Services? • RN Assessments and Follow up Visits • Caregiver Match • 24-Hour On-Call • Alzheimer’s/Dementia Care Specialists • Licensed-Bonded-Fully Insured • Family Owned and...
At One to One Home Care Agency, our mission is to enhance the quality of life for our clients through compassionate, personalized home care services. We are dedicated to providing exceptional, individualized care that...
If you or someone you love needs in-home assistance, contact FirstLight Home Care Greater Charlotte. Whether you’re a senior, a new mother, someone recovering from surgery or you just need extra help, FirstLight Home Care...
Welcome to Home Care Freedom. As a home care provider, we want you to trust us with your personal and health needs. We proudly provide non-medical home care services to individuals with disabilities, injuries,...
Our home health care services are delivered via a multidisciplinary approach tailored to each individual’s health needs. We work closely with our clients and their families every step of the way, respecting their...
PACE of the Southern Piedmont is here to help you continue living in the home and community you love. The Program of All-Inclusive Care (PACE) is a Medicare not for profit, Medicaid State option program. We serve...
Choosing the proper home care agency for yourself or a senior loved one is something most people are not prepared for, but Amada Senior Care of West Charlotte is here to show you the way. Korey Sixbury, owner of Amada...
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...
When you choose Eternal Love and Gracious Hands Home Care as your care provider, you choose a compassionate company that puts your needs first. We provide personalized services based on the level of care you or your...
BlueDot Cares is a family-owned and operated, in-home care company that provides personalized senior living solutions for people of all ages. BlueDot Cares makes it easy for you or your loved ones to stay safe and...
Gentiva Health Services/Charlo is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Greenleaf Homecare , we believe everyone has the right to receive high-quality care in the comfort of their own homes. We provide exceptional and compassionate in-home care services to seniors, veterans, and the less...
Partners in Care, LLC provides non-medical in-home care to those in need who wish to remain independent in their own homes for as long as possible. Our caregivers provide assistance with errands, incidental...
Caring Companions has proudly served our community since 2008. Our dedicated staff brings more than 28 years of elder care experience and is available to assist our clients 24 hours a day. We strive to be the best...
A Tranquil Care Home Agency is an accredited provider of Skilled Nursing and non-skilled services in Charlotte, North Carolina. Endorsed by the Accreditation Commission for Health Care (ACHC) to provide professional Home...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
Always Best Care combines national strength and standards with local accessibility and personal service. Your local Always Best Care team will be helping families throughout Matthews and surrounding communities providing...
Universal Home Care Services of Charlotte NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Covenant In Home Care is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Personal Home Care Of North Carolina, Llc is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Choosing a reliable Home Care Agency is a crucial step to ensure your family members will have the level of care they deserve. The needs of your family are always in our focus and everything we do is dedicated to your...
BrightStar Care of SW Mecklenburg County, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Potter's House Home Health Care is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ofa's Private Home Care Services is a home care provider that services in Charlotte, NC. 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...
A Better Day Home Care Services, Inc. is dedicated to delivering quality patient care and service to maintain the highest possible level of independent living for our clients. Our approach to quality care focuses on a...
Living Ease Home Care, Inc. was established in 2014 in Charlotte, NC as a care management company. Later in 2019 the company started doing business as “Living Ease Home Care.” In addition, we provide in-home aides,...
Bayada Nurses is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Total Care of North Carolina is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Outstanding Care Of Charlotte LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Better At Home is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Liberty Home Care Ii, Llc is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Health Professionals is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Total Care Home Health is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
AccordCare -Charlotte, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Visiting Angels, we strive to make staying at home a positive experience. We do this by allowing you to select your caregiver from a group of skilled elderly home care providers, allowing you to maintain your schedule,...
Since 1975, Bayada Nurses has helped people have a safe home life with comfort, independence, and dignity. Bayada Nurses provides skilled, rehabilitative, therapeutic, and personal home health care services to children,...
Seniors Helping Seniors - Charlotte, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Interim Healthcare of the Tria is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Comforting Moments Home Health Care LLC of Charlotte, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or...
Premier Home Health Care's mission is to provide high quality home health care services to individuals and their families at home and to provide health care personnel staffing services and programs for Certified Home...
Top Notch Nursing & Staffing Home Care - Charlotte, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Affordable HomeCare was formed by a team of seasoned professionals with a combined experience of more than sixty years, in the field of healthcare.We are dedicated to bringing quality home care services to our clients,...
Senior Helpers Charlotte is the premier provider of in-home senior care. We offer tailored home care services ranging from companion care for seniors who need daily assistance to in-depth specialized care for those with...
Experience a Better Way to Age with Gentle Shepherd Care. Gentle Shepherd Care provides At Home Care services in the Charlotte Metro Area, and Eldercare Management and Lifecare Planning services nationwide. Our support...
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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.