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:
At Gentiva Personal Care, our Personal Home Care Assistance can assist with personal care, daily living necessities, and help around the home. If you or a loved one is struggling with prolonged illness, recovery from...
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AHC is a trusted and dependable non-medical home-care provider. Our priority is to provide our clients with continuity of care and preserve the Our top priority is to provide our clients with continuity of care and to...
Home Instead can help with compassionate, home senior care services delivered right in your loved one's home. Whether a few hours a day or long-term care 24 hours a day, a CAREGiver can assist you. All CAREGivers are...
Caring is what we do. We provide the in-home care needed by any elder hoping to live a comfortable and safe life at home. We also offer specialized Alzheimer's care as well as Hospice and end of life care. All of our...
My Caregivers Inc is a home care provider that services in San Francisco, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Interim HealthCare of San Francisco, CA, we know how important it is to be in a comfortable, familiar environment. We all value our independence, however, sometimes the best way to maintain our autonomy, or preserve...
Senior Helpers of Greater Marin was established in 2020 by Sean and Caroline Ziegler, who are advocates for high-quality senior care. At Senior Helpers of Greater Marin, our primary goal is to help provide a high quality...
At Interim HealthCare of San Bruno, CA, we know how important it is to be in a comfortable, familiar environment. We all value our independence, however, sometimes the best way to maintain our autonomy, or preserve that...
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...
Professional Medical Resource started it's operation in Chicago,Illinois in 1976. PMR provides the best professional care in the field of care giving. Our professional staffs have the ability to care for the elderly...
Sutter Visiting Nurse Association and Hospice is a home care provider that services in San Francisco, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Welcome to ChoiceCare – Providing care management and in-home care services. ChoiceCare is your one-stop solution for those difficult questions concerning the care of your older love one. If your time is precious and...
American Carequest is a home care provider that services in San Francisco, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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IRISH HELP AT HOME LLC is a home care provider that services in San Francisco, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ucsf Home Health Care is a home care provider that services in San Francisco, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Health Link Home Health Agency is a home care provider that services in San Francisco, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
CareSimply is the best way for families to find and hire high quality, affordable home care. Use CareSimply’s online directory to find your perfect caregiver. Caregivers must pass a rigorous screening process that...
Our office is located in San Francisco and we serve the whole Bay Area. We provide quality homecare services to the elderly and your loved ones 24 hrs. a day, 7 days a week with live-in care an option. Our caregivers...
Precious Home Companion is a full service home care agency whose mission is to improve the quality of life of the people and the communities we serve by providing compassionate, reliable and exceptional home health care....
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Reliable is a home care agency that provides in-home caregiving support for seniors and those in need of assistance. We believe that the home is the optimum setting for healing and we are delighted to help our clients...
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OptionONE Care At Home is based in San Francisco’s financial district, and provides non-medical home care anywhere in California. We deliver reliable and compassionate based on a simple formula: We care for people the way...
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Allied Care Bay Area Home Care provide a wide range of non-medical personal care services to anyone in need of some assistance with the routine demands of daily life. Those benefiting from our services include seniors and...
At Herewith we understand it is difficult finding compassionate, dependable caregiver services. We believe that families want the best for their loved one - that’s why our program includes allowing the family to...
PURE LOVE AND CARE LLC of San Francisco is a home care provider that services in San Francisco, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Mavis, our team is dedicated to providing compassionate services that help create quality of life for you and your family. We meet individuals and families wherever they are in their healthcare journey and provide...
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Home Care ServicesHome care services allow seniors to remain in the comfort of their own home and community. We serve clients in their homes, assisted living communities, hospitals and nursing homes.Depending on the...
Kaiser Foundation Hosp Home Health - San Francisco is a home care provider that services in San Francisco, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance...
Institute on Aging Senior Campus (IOA) is a home care provider that services in San Francisco, CA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
As a boutique agency with a discerning clientele and handpicked caregivers, we pride ourselves on delivering exceptional, personalized care tailored to your unique needs. At SF Home Care, we care about the details.
Home Care Agency with over 20 years experience serving seniors and those who wish to remain in their own homes. We are the caregiver's employer. This relieves you of additional payroll, taxes and insurance calculations....
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It’s human nature to want to be independent and self-sufficient, but there are times in our lives when we need a helping hand. Are you a new parent and feeling overwhelmed? Are you recovering from an especially...
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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.