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 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,...
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...
Senior Helpers - Irving, TX is a home care provider that services in Grand Prairie, 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...
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...
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...
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...
Discover Hallmark Homecare, your premier referral agency connecting you with top-tier independent, professional caregivers for a direct-hire experience. Embrace our mission: Empowering seniors to lead fulfilling and...
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...
Senior Helpers connects caring, professional caregivers with seniors when assistance is needed so they can remain where they are most comfortable. We offer a wide range of personal and companion care services to assist...
Maranatha Home Health is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Jcare Home Health Agency LLC is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our mission is to work with you to provide the best services for your loved ones so that they may maintain an optimal level of care provided through non medical healthcare services. We will help you design a plan that...
Ameritex Home Care Inc is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Rapha Health Care Services is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Carisma's Care Home Health Agency - Dallas, TX is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Integrity Home Health Care Services is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
1st Precious Home Healthcare Agency of Grand Prairie, TX is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or...
Apex Homecare Inc is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Floric Home Healthcare Agency is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Omega Home Healthcare Agency is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ultimate Care Home Health Services is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Kemg Home Health Care is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Good Hands Care Home Health Services Inc is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Concord Home Health Services LLC is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Family Connections Home Health Care is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Community Care Health Agency Inc is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Anointed Caregivers Community Care is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
With old age hampering your ability to function with the same energy as before, you need someone to manage your chores and responsibilities at all times. And well, AMAT Home Healthcare Services LLC is here to lend a hand...
KM Home Health Services is a home care provider that services in Grand Prairie, TX. 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,...
Vana Home Health Inc is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Covenant Plus Health Care Inc is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
PRIME CARE SERVICES HOME CARE INCORPORATED is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
PEACEFUL KEEPER FAMILY SERVICES is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Immaculate Healthcare Services Inc is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Triple Agi Home Health is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
La Monique Home Health Services is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
1st Precious Home Healthcare Agency is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Angel Care Home Health Services Inc is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Prudent Choice Homecare Service Inc is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Keystone Healthcare Inc is a home care provider that services in Grand Prairie, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our caregivers and personal assistants help overcome challenges and make home an even better place to be. We include everything from specialty senior care, Alzheimer’s and Dementia care, personal companion services,...
At HomeWell Care Services, we provide hourly at-home care for seniors and others who are struggling to manage day-to-day activities like grooming, bathing, cooking or even running errands. Our knowledgeable Care Managers...
AccuAid Care Services provides companion care, personal care, respite care, and dementia care wherever older adults need it. Whether you or your loved one needs help due to injury, illness, or age related decline, we are...
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...
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...
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.
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....
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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.