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,...
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...
HomeWell Care Services of Plano, TX, is a full service in-home care firm serving the larger North Dallas, TX, area. HomeWell Plano was built by caregivers who cared for their parents before and after joining the in-home...
Our path is simple- to make a difference to our clients while helping them achieve their best selves, providing best possible individualized care from people who truly care. We understand life has lots of journeys and...
We understand that home care needs extend beyond the traditional work hours of 9 to 5. That's why our North Dallas team is available 24/7 to address any questions or concerns that you might have. Reach out to us any time...
Hello! We are Marshall & Kacy Oden and we would like to welcome you to the Griswold Home Care Office of Garland, TX. We independently own and operate the Garland office and are very proud to offer affordable, high...
To provide professional, compassionate and personalized home health care services to our clients that empower individuals to maintain their independence and improve their quality of life. We are committed to delivering...
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...
Life moves in one direction – forward. No matter what each person’s circumstances are, SYNERGY HomeCare steps in with effective, comforting, life-affirming care that moves people, and their loved ones, emotionally and...
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...
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...
At Nightingale Family Healthcare Services, Inc, we’ve nurtured the legacy of the legendary nurse Florence Nightingale for over a decade. Reflecting her ideals in our name and our ethos, we strive for excellence in all our...
Kan Healthcare Agency Inc is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Kalibra Home Care begins with an initial in-home, confidential assessment to determine your loved one’s needs. This allows us to create a service plan tailored to you and your family’s situation. Once the service plan...
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,...
Credence Home Health Services Inc is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
SUPPORTIVE IN HOME CARE LLC is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Instead - Richardson, TX - Duplicate is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Logos Healthcare Services is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The senior care services of Caring Senior Service are tailored to meet your personal needs. You will receive one-on-one care from a professionally trained caregiver that understands your needs and that will provide care...
MY Redeemer Healthcare Services and Consult LLC is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Precious Care Home Health Inc is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Century Home Healthcare Services LLC is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Abasap Home Health Care LLC is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Lucent Home Health LLC is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Peace Home Health Inc is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Reachout Home Care + is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Superior Home Health Care is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Acti-Kare provides in-home elderly care to thousands of individuals every year and has constantly been ranked a leading senior and elderly care company across the United States. We are committed to providing outstanding...
SHALOM HOME HEALTH SERVICES is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Midas Healthcare Services Inc is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Timely Home Health Services Inc is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
EHCS is dedicated to becoming a servant leader in the home care industry. We exist to enhance the quality of life for our clients and to promote independence and healing in the comforts of their home. Book an appointment...
Diamond Care Health Services LLC is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
NB MED SERVICES is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
SeniorBridge services are a PRIVATE PAY offering of Humana At Home - a division of Humana, one of the leading healthcare companies in the country. Our goal at Humana At Home is to help people, even when faced with medical...
Criskel Home Health Inc is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
AA Care Services is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Good Shepherd Home Healthcare Agency is a home care provider that services in Richardson, TX. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Advocate Home Healthcare Services Inc is a home care provider that services in Richardson, 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...
Visiting Angels - Richardson, TX is a home care provider that services in Richardson, 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...
When you or your loved one need help at home, turn to FirstLight Home Care. We offer complete companion and personal care services for seniors, new mothers, those recovering from surgery, or anyone who just needs a little...
Home Helpers® Home Care is a home healthcare service that has been providing top quality in-home care for over 25 years. Our Cared-4℠ program is a holistic approach to meet the four primary areas of need, helping your...
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....
At Griswold Home Care of Plano, our mission is to provide outstanding home care services from outstanding caregivers. Griswold Home Care allows seniors to stay in the home that they love, while maintaining their...
Senior Helpers of Richardson offers companion care, personal care, and chronic disease care to seniors in the Greater Dallas area. We help you to decide what care service is best for your loved one and family and...
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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.