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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:
At Priority Home Care, we understand that each individual has unique needs and preferences. That’s why we’re committed to providing personalized solutions tailored to you or your loved one. Our dedicated team of...
Senior Helpers of Marietta places a priority on creating safe, caring and compassionate environments for all clients, while providing ongoing communication and follow-up plans which offer peace of mind for family members....
Your nearest All Ways Caring office is your gateway to all of our quality services, programs and support. Each local office provides the staffing, resources, commitment and experience to ensure that your loved one can...
Home Instead Kennesaw has been providing extensive in-home care services in the Atlanta area for over 15 years. Home Instead can tailor a home care arrangement to fit both your family's lifestyle and budget.
Charlotte Web Private Home Care, LLC is a home care provider that services in Powder Springs, GA. 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...
To be Georgia's most trusted home care agency, delivering compassionate, personalized, and innovative care solutions that empower individuals to lead independent and fulfilling lives in the comfort of their own homes. We...
Our team of highly skilled professionals offers a range of services, including medical care, personal assistance, and companionship, tailored to meet the unique needs of each client.
CareBuilders at Home is a premier provider of in-home care services, dedicated to enhancing the quality of life for seniors and individuals with disabilities.
Quality, trust and compassion are the foundations of 4 Seasons Home Care. Owned and operated by a registered nurse, our caregivers enhance the lives of seniors across the Atlanta area.
We prioritize dignity, independence, and quality of life, ensuring that every individual receives the best possible care in a safe and supportive environment.
Our team of highly skilled professionals offers a range of services, including medical care, personal assistance, and companionship, tailored to meet the unique needs of each client.
Dantily Homecare LLC provides home care services in Georgia. We use our skills and knowledge to accommodate the various needs of our clients. By personalizing them according to their health situation and needs, we address...
ANGELIC COMPANIONS CARE SERVICES, LLC is a home care provider that services in Powder Springs, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Hearts of Love Caregivers helps families with non-medical in home care. We offer in home health care in select locations. With Hearts of Love Caregivers, every client receives extra ordinary care from our caring team. We...
At AGAPE Healthcare Solutions LLC, our mission is to revolutionize healthcare delivery by providing innovative, patient-centered solutions that enhance the quality of care, improve patient outcomes, and streamline...
Arose Home Care Services LLC, located in Powder Springs, GA, provides compassionate non-medical home care services. They assist individuals with daily living activities, including personal care, meal preparation,...
DELIGHT HEALTHCARE SERVICES LLC is a home care provider that services in Powder Springs, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Rose Garden Healthcare Services, LLC of Powder Springs, GA services are tailored to cater to your loved ones' needs to maintain and refine their quality of life. We establish a routine and care plan that will help your...
At Arose Home Care Services, our caregivers are highly qualified and trained to meet all aspects of our patients needs. We screen our caregivers carefully to ensure that all references and background checks are complete...
We prioritize dignity, independence, and quality of life, ensuring that every individual receives the best possible care in a safe and supportive environment.
Bethel Private Homecare is a home care provider that services in Powder Springs, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Visiting Angels of Powder Springs, GA is a home care provider that services in Powder Springs, GA. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
We are a Christian based company, family owned and operated. We specialize in Private Duty Non-Medical Homecare in the comfort of your own home. We exemplify an unsurpassed passion for serving those in need of services,...
Its Home LLC is a trusted home care agency based in Atlanta, Georgia, providing personalized and compassionate care services to individuals in the comfort of their own homes.
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.