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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FirstLight Home Care of Colorado Springs is there for you and your loved ones. Our dedicated caregivers provide home care services in Colorado Springs and Castle Rock and can offer both companionship and personalized...
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Aide To You Home Care proudly provides non-medical home care services to individuals with disabilities, injuries, difficulties with mobility, or illnesses. We are composed of highly trained and competent staff members who...
Visiting Nurse Association-Colorado Springs is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Teamselect Home Care is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Nursefinders of Colorado Springs is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Coach Home Care of Colorado Springs, CO is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At BrightStar Care® of Colorado Springs, our fully screened and certified care professionals are available to assist with daily activities that require a little more hands-on, personal support like personal hygiene,...
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BrightStar Care of Colorado Springs, CO is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Home Health Partners Inc is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Professional Home Health Care Inc is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Right at Home - Colorado Springs, CO is a home care provider that services Colorado Springs, CO 80907. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our Professional In Home Senior Caregivers have been carefully screened, passed rigorous skills testing and are insured, licensed and bonded. They possess the skills, experience, training and certifications necessary to...
Golden Care is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Welcome to SYNERGY HomeCare of Colorado Springs - SYNERGY HomeCare is Colorado Springs' premiere home care agency. We are locally owned and operated and are thrilled you found us! Our commitment is to help you and your...
At HomeWell of Pueblo, CO we provide live-in and hourly 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...
Home Services, Inc is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Talem Home Care - Colorado Springs, CO is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Human Touch Home Health Care Agency, Inc is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
TheKey Corporate - Colorado Springs, CO is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are a senior home care service that allows your loved ones to stay where they feel most comfortable: at their home in The Springs or in surrounding areas like Briargate, Powers, or East Colorado Springs. Our trusted...
Mga Home Healthcare Colorado Inc is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Maxim Healthcare Services is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
1 For All Home Healthcare LLC is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our Mission - For many older people, home is everything. It’s a window to the past, a safe haven for the present and the legacy they long to leave for the next generation. Since 1984, the husband-and-wife founders of...
Healthsouth Home Health of Colorado Springs is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Family Home Health Care is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Kind Heart Home Health Care of Colorado Springs, CO is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or...
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...
Right at Home Greater Colorado Springs is proud to be an award-winning home care provider! Over the past few months, Home Care Pulse® conducted telephone interviews with our clients and caregivers; based on their feedback...
Gentiva Health Services is a home care provider that services in Colorado Springs, CO. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Heartfelt Care at Home is a locally owned and operated (non-franchise), full-service senior care company. Although we specialize in providing one-on-one home care services to seniors and disabled adults; Heartfelt Care...
Ken Jenson, owner of Amada Senior Care Colorado Springs and Denver, is a devoted family man who believes that, just like everything else in life, senior care should always be a family endeavor. To Ken, even if he and his...
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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,...
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.