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:
Senior Helpers of Glendale advocates for the highest quality of in-home care for seniors in the Glendale and surrounding Milwaukee community. Owner Jamie Miller has a passion for helping the elderly that began when he was...
So many people have a parent, aunt, or loved one who is a senior. However, most people don’t realize the minefield that is ahead of them in trying to care for their loved one as they age. More and more people every day...
Our mission is to meet the client’s needs as if they were our own. By meeting the client’s needs we (staff) will act in a professional manner at all times, while providing excellent services. This means delivering...
Affiliated Home Hlth Care is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Gentiva Hlth Svcs is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Preferred Home Hlth Svcs is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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...
Heartland Hm Hlth Care And Hspc is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Omni Personal Care of Wauwatosa, WI is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Horizon Home Care and Hspc is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Midamerica Hlthcare Co of WI is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Regal Home Hlth Svcs is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Anew Home Hlth Care is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Samaritan at Home Care is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
United Home Care provides home care services in the homes of seniors, the disabled, or anyone that needs extra help around the house. Our mission is to help you or a loved one maintain their independence and safety in...
Ans Home Hlth Svc is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Amedisys Home Health is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
In Home Personal Care Services Of Milwaukee, Wi is a home care provider that services in Milwaukee, WI. 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,...
Laabs Home Hlth Care is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Homewatch CareGivers of Wauwatosa, WI is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
TheKey Corporate - Milwaukee, WI is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Qual Assurance HM Hlth Svcs is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Outreach Hlthcare is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Tko Homecare, LLC is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Trinity Home Health Inc is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Badger Care Home Health Services of Brown Deer, WI is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Thank you for your interest in Home Care Assistance of Wisconsin. We offer hourly and 24/7 live-in caregivers throughout Southeastern Wisconsin, from Milwaukee to Madison. Our trained, expert care professionals are the...
Community Home Health Care, Inc is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Prof Homecare Svcs is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Aseracare Home Health is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
By Your Side Hospice - Milwaukee is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Maxim Hlthcare Svcs is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
ROBYNNS GIFTED HANDS OF LOVE is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Wheaton Franciscan Home Hlth is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
The mission of Essential Home Care Living, LLC is to provide Personal Care Services, Supportive Care Service and Respite Care Services to our clients. We do this by providing services that are medically oriented...
Regal Home Hlth Svcs is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Life Touches Home Healthcare of Southeastern, WI is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Your Nurse Hhc Inc is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Camillus Cares Home Hlth is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Dynamic Home Health is committed to providing high-quality, client-centered, and affordable personal care services to our clients to assist them to lead dignified and independent lives in the comfort and safety of their...
Family Focus Healthcare Services is a home care provider that services in Milwaukee, WI. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are more than an in-home health care agency: we are your extended family when family cannot be there. Home Helpers of Waukesha and Milwaukee County is locally owned and a trusted provider of quality, compassionate...
Metro Home Hlth Svc is a home care provider that services in Milwaukee, WI. 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...
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...
BrightStar of Central Milwaukee is driven to serve people. Our values reflect a strong commitment to the highest quality of care, above and beyond customer service, and outstanding communication. Our staff is determined...
Right at Home Southern Milwaukee has been selected to receive the 2023 Provider of Choice, Employer of Choice, and Leader in Experience awards from Home Care Pulse. We are proud of our incredible staff and highly trained...
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.