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:
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Our home care services can help aging adults stay engaged in everyday life with tailor-made support by professional caregivers to stay safe and well at home. It’s our mission to provide a care plan personalized to your...
FirstLight Home Care of McKinney is a locally owned and operated home care agency dedicated to helping seniors and adults live safely, comfortably, and independently at home. Owners Kolawole and Lolade Akintade are proud...
Home care enables you or your loved one to continue living in the comfort of home with assistance from a qualified home care provider. We respect the many factors and careful thought that go into making decisions for the...
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Oliver Araiza, owner of Senior Helpers East Dallas, Garland knows getting the best care for your loved one should not be difficult. Oliver is dedicated to his community and supports elderly clients by offing them a better...
Our Senior Helpers team of caregivers is dedicated to helping our senior neighbors stay independent and comfortable, whether at home or in a facility. We take pride in offering personalized care that not only enhances...
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We are an in-home personal and companion care agency that has helped families all over Dallas and surrounding areas. We have a Personal Assistance Services License issued by the Department of Aging and Disability Services...
FirstLight Home Care is the go-to home and senior care provider in Plano, TX! Our quality caregiving solutions are perfect for the elderly, those recovering from surgery, or anyone needing help with personal care or daily...
Senior Care Transitions, LLC is a home care provider that services in Plano, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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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...
LoveWell Home Care is a compassionate, client-centered home care provider serving seniors and families throughout the Dallas–Fort Worth metroplex. Our mission is to help individuals maintain their independence, dignity,...
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Patient Centered Services Inc is a home care provider that services in Plano, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Comfort Givers Home Care LLC, we prioritize compassionate and reliable in-home care, fostering independence and enhancing well-being. Our dedicated caregivers provide personalized support, from assistance with daily...
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Koc Healthcare Services Inc is a home care provider that services in Plano, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heilan Care, LLC is a home care provider that services in Plano, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Americansenior is a home care provider that services in Plano, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Lifegate Healthcare Services Inc is a home care provider that services in Plano, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Omnicure Home Health is a home care provider that services in Plano, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Whether providing short-term assistance or long-term support, our team is committed to enhancing well-being and fostering peace of mind for both clients and their families.
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Applecare Home Health Services Inc is a home care provider that services in Plano, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Discover the Compassionate Care Difference at Dayspring Home Healthcare At Dayspring Home Healthcare, we believe that healing and quality of life begin at home. That’s why our services are designed around you—your...
Our Mission Protect dignity. Support independence. Deliver care families can trust. At Domira Home Care, our care philosophy centers on relationship-based, client-focused support that helps individuals remain safe,...
At Cloud9 Private Caregivers LLC, we believe that compassionate care begins at home. Our experienced caregivers provide personalized assistance with daily activities, companionship, and specialized support, ensuring each...
At Mount Flo LLC, we are committed to delivering personalized in-home care that enhances the quality of life for seniors. Our dedicated team provides a range of services, from companionship to skilled nursing, ensuring...
Comfort Keepers of Carrollton provides compassionate, customized in-home care services for seniors and disabled individuals throughout Carrollton and surrounding communities. Their trained caregivers offer companionship,...
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.