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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Always Best Care combines national strength and standards with local accessibility and personal service. Your local Always Best Care team will be helping families throughout Matthews and surrounding communities providing...
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HomeWell Care Services of Huntersville, NC serves Charlotte, NC and surrounding areas. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with personal care and...
PACE of the Southern Piedmont is here to help you continue living in the home and community you love. The Program of All-Inclusive Care (PACE) is a Medicare not for profit, Medicaid State option program. We serve...
Since 1996, Always Best Care has helped thousands of families with non-medical in-home care and assisted living referral services. Our passion for helping people maintain a safe, independent and dignified lifestyle...
Always Best Care combines national strength and standards with local accessibility and personal service. Joanne Pizzuto, Gina Ward and Andrea Allegretto, the owners of Always Best Care-Winston-Salem, are local residents...
We prioritize dignity, independence, and quality of life, ensuring that every individual receives the best possible care in a safe and supportive environment.
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...
BlueDot Cares is a family-owned and operated, in-home care company that provides personalized senior living solutions for people of all ages. BlueDot Cares makes it easy for you or your loved ones to stay safe and...
Empowering you to live independently at home. If you love your home and plan to stay right where you are, Aldersgate At Home is the perfect solution for seniors. Created by the most respected Life Plan Community in...
Along with our excellent home care, A New Pathway LLC eliminates the stress and worry family members are experiencing over the care of their loved ones.
Alternative Living Solutions of North Carolina is a Non-Profit outpatient home health company founded by Stephanie Shine-Morrison. We aim to make sure that all of our patients needs are thoroughly taken care of. We offer...
Autumn Carolina, LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Assurance Home Care Service, LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A Tranquil Care Home Agency is an accredited provider of Skilled Nursing and non-skilled services in Charlotte, North Carolina. Endorsed by the Accreditation Commission for Health Care (ACHC) to provide professional Home...
Carepoint, inc is a Charlotte-based Home Care agency offering personal care, companion, homemaker, and transportation services to those adults and seniors wishing to remain independent. Exceptional care is truly our...
Carolina Haven PCS, Inc. is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Choosing the proper home care agency for yourself or a senior loved one is something most people are not prepared for, but Amada Senior Care of West Charlotte is here to show you the way. Korey Sixbury, owner of Amada...
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Since 1975, Bayada Nurses has helped people have a safe home life with comfort, independence, and dignity. Bayada Nurses provides skilled, rehabilitative, therapeutic, and personal home health care services to children,...
Abundant Love Home Care Services, LLC provides in-home personal care services in Charlotte, North Carolina, and the surrounding areas. Our assisted living services give any homebound individual the help they need to...
Blake Home Health Care LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
BrightStar Care of Charlotte, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
A Plus Home Care Services LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Better Living Home Health Care of Charlotte provides a wide range of homecare services including adult and pediatric skilled nursing, non-medical companion and personal care, as well as medical staffing.
With Alliance Health and HomeCare, families find peace of mind in our caregivers providing companionship, nurturing support, and helping their loved ones heighten their quality of life in the comfort of their own homes.
Caring At Heart began out of a concern for how home care agencies treated their clients and handled their business. Believing that families deserve better than what was being offered, a compassionate and...
Ally Home Care Charlotte, LLC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Who are we 1st Serenity Healthcare Registry is locally operated in the Charlotte metro area. Our team of well qualified healthcare professionals and in partial partnership with Home Care Seminars (one of the oldest...
AccordCare -Charlotte, NC is a home care provider that services in Charlotte, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Choosing a reliable Home Care Agency is a crucial step to ensure your family members will have the level of care they deserve. The needs of your family are always in our focus and everything we do is dedicated to your...
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A New Beginning Community Care LLC is a dedicated and compassionate provider of community-based healthcare services. The organization is committed to delivering high-quality, personalized care to individuals in need,...
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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.