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.
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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:
The Right Touch, Inc. is an in-home care company dedicated to providing compassionate, personalized care to individuals in their own homes. Offering non-medical services such as assistance with daily activities,...
Age in Place - Philadelphia/Montgomery Region is a home care provider that services in King Of Prussia, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
We specialize in home healthcare services and daily living assistance to an array of individuals. Whether you need daily or weekly assistance due to aging, illness, recovery, or rehabilitation, our caregivers will provide...
Amada Senior Care of Bucks and Montgomery County, PA is a home care provider that services in King Of Prussia, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or...
Allegiant Home Healthcare is a family owned and operated non-medical home care company. We have a combined 35 years of experience in the home and health care industry. Our experience, expertise and loyalty to the...
Our founder Quiera Dover watched many patients, seniors, and clients with intellectual disabilities fight to gain independence and decline in their ability to do for themselves. Quiera found that most seniors want to be...
Accessible Home Health Care is committed to providing the highest level of in-home care to improve the health, wellbeing, and comfort of families all over the country. Each Accessible Home Health Care location is...
Options for Senior America Wayne PA is a home care provider that services in King Of Prussia, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A Different Care Home Care LLC is a home care company based in Philadelphia, PA, specializing in providing non-skilled in-home care services. Their offerings cater to individuals who need assistance with daily living...
HomeWell Care Services of Norristown, PA is a home care provider that services in King Of Prussia, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Essence Home Care, LLC is a home care provider that services in King Of Prussia, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BrightStar Care of W. Montgomery Co. offers in-home care and medical staffing that goes above and beyond. We call it “A higher standard." Our Professional Care Team, led by a Registered Nurse Director of Nursing,...
We are a home care agency in Ardmore, PA that is dedicated to delivering exceptional quality care and making sure all of your loved one's safety and personal care needs are met. Clementine Home Care, LLC is not only...
The Mission of the Health Angels Home Health Services LLC is to enable patients under our care to live independently and retain a sense of freedom of choice as they age. Our specialists work closely with the patient,...
Tata Homecare Services LLC is a home care provider serving Montgomery and Bucks County, offering a range of services that allow seniors to safely remain in their homes while receiving essential care.
At Homewatch CareGivers, we pride ourselves on being one of the oldest and most trusted providers of customized in-home care services. We know that inviting someone into your home is an important and complex decision,...
Adored by Me Home Healthcare Agency believes that homecare should be offered and made available to everyone who is in need of medical attention. Getting access to homecare should not be limited to select individuals but...
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...
Home Matters of Philadelphia-- Montgomery County is a home care provider that services in King Of Prussia, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Our team of highly skilled professionals offers a range of services, including medical care, personal assistance, and companionship, tailored to meet the unique needs of each client.
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...
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,...
Childrens Hosp Home Care is a home care provider that services in King Of Prussia, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Synergy HomeCare, the most trusted name in non-medical home care, stands out from the rest because we provide home care services to all ages—we can work with anyone in any age range and with any home care need. We also...
A Place at Home - Glenside, PA is a home care provider that services in King Of Prussia, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Reliable Caregiving Angels, L.L.C. is a healthcare company dedicated to offering compassionate and dependable companion services to individuals who need assistance with daily activities. The company’s mission is to...
Jireh Home Care LLC is a home care provider that services in King Of Prussia, PA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Elder Home Care is a family owned (non-franchise) home care agency providing care to seniors throughout New York and Philadelphia. Our experienced staff (each with over 20 years in home care) are committed to providing...
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...
A Tradition of Homecare Excellence Griswold Home Care is a non-medical homecare company. We refer Caregivers who provide personal care, homemaking, meal preparation, companionship, incidental transportation and other...
For more than 10 years, Senior Helpers has been providing customized professional care services to seniors and families throughout the Pottstown area. To support aging in place, we provide a full variety of services...
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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.