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.*
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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:
Home Instead - West Cave Creek, AZ is a home care provider that services in Glendale, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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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,...
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Gold Star Home Care LLC is a home care provider that services in Glendale, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
You deserve to have the optimum level of health and comfort. Whenever life’s difficulties hinder you from achieving wellness, then we are here to provide you with home care services that are specifically structured to...
HomeWell Care Services of Phoenix, AZ is a home care provider that services in Glendale, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Gentiva Personal Care - Glendale, AZ is a home care provider that services in Glendale, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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Amada Senior Care Phoenix West Valley's mission is to deliver the greatest quality in-home senior care and to assist families in managing their senior loved ones’ care needs. This entails identifying the finest caregiving...
Home With Help is a trusted provider of comprehensive non-medical companionship / home-making and Personal Care Services in the Greater Scottsdale, Phoenix Arizona. We are committed to providing the most compassionate,...
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...
At HomeWell, we address the immediate needs of clients while anticipating future challenges to bolster and protect their well-being as they age. We are dedicated to the long-term effects of a masterfully-crafted care...
Valley Home Care, LLC is a home care provider that services in Glendale, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
HomeWell Care Services of Glendale, AZ is a home care provider that services in Glendale, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ableminds Healthcare is a home care provider that services in Glendale, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Healthsouth Home Health of Phoenix is a home care provider that services in Glendale, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Arrowhead Home Health, Inc is a home care provider that services in Glendale, AZ. 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,...
Seniors Helping Seniors of Glendale, AZ is a home care provider that services in Glendale, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Loving Legacy Care Services, we provide support to individuals and families in the areas of personal care, daily living activities, housekeeping, respite care, and companionship. We care for seniors who need assistance...
At Cherished Moments Home Care Services, we provide reliable and affordable home care services to clients in the Phoenix Metro area. Whether you need help daily assistance or are looking for appointment based care — you...
Love In Action Homecare is a home care provider that services in Glendale, AZ. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are dedicated to providing our clients with home care in Glendale, AZ. At On Call Home Care, our team of caregivers is here to help you with assisted living services, including companion care and Dementia care. You can...
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...
Acti-Kare of Glendale provides quality in home care services to families and seniors in Glendale, Peoria and parts of northern Phoenix. Our carefully selected and qualified caregivers deliver compassionate care with in...
Right at Home Northwest Phoenix knows aging is not easy. Not for the person who is feeling the effects of the years. Not for their family members. As a person begins to age, family members are often called on to help with...
PrimeCare Home Solutions in Peoria, AZ provides professional, affordable and compassionate in home care for seniors and others needing assistance. We are not just a provider of home care services; our mission is to be a...
Senior Helpers of Glendale is the premier provider of senior care in the valley. We provide personalized in-home care as well as care in assisted living facilities and group homes. We offer tailored services that range...
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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.