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:
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Trustiva Health is a privately owned home care company specializing in patient care and advocacy across Oakland, Macomb, and Wayne counties. With over 60 years of combined experience, our compassionate caregivers provide...
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SYNERGY HomeCare of Northville - Livonia, MI is a home care provider that services in Farmington, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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CarePRN’s mission is to provide passionate and reliable care to seniors with caregivers who love what they do. We pride ourselves on delivering high-quality care that promotes independence and well-being, and we believe...
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Oakland Home Health Care, Inc is a home care provider that services in Farmington, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Great Lakes Care Partners is a home care provider that services in Farmington, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Griswold is an award-winning pioneer in the home care industry, with over four decades of experience and a storied legacy of compassion and integrity. We believe Care Professionals are the foundation of our success, and...
Amethyst Center Inc is a home care provider that services in Farmington, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Angels at Home Care - Farmington Hills is a home care provider that services in Farmington, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Delicate Hands Home Care, we believe that compassionate care begins at home. Our experienced caregivers provide personalized assistance with daily activities, companionship, and specialized support, ensuring each...
Better Life Homecare of Farmington Hills, MI is a home care provider that services in Farmington, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Innovative Senior Care Home Health is a home care provider that services in Farmington, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The Three Advantages of using Excellacare for your home health care needs. 1. Excellacare is an economical solution to having care provided in the comfort of your home. You can receive many of the same types of...
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Seniors Helping Seniors - SW Oakland/ NW Wayne County, MI is a home care provider that services in Farmington, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or...
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Dreamers Home Health Care LLC-Farmington Hills-MI is a home care provider that services in Farmington, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heritage Home Care is a home care provider that services in Farmington, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are delighted to have this opportunity to tell you about the benefits of our in-home, private duty personalized living assistance services. Whatever your non-medical care needs, for you or a family member, temporary or...
At Prodigy Unlimited Care, we are committed to providing personalized care. Our caregiving services address the specific needs and preferences of each client. Our caregivers are not only passionate and experienced. They...
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In-Home Care Overview – Senior Helpers of Farmington Hills, MI At Senior Helpers of Farmington Hills, we believe that every senior deserves care that truly focuses on what matters most to them. We are proud to be one of...
Comfort Care Home Care Assistance - Grosse Pointe is a home care provider that services in Farmington, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Carter’s Caring Services is a home care provider that services in Farmington, MI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Smith's Loving Home Healthcare Services LLC, Compassionate In-Home Care Services At Smith's Loving Home Healthcare Services LLC, we are committed to providing high-quality, non-medical in-home care services 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...
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...
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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.