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.
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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:
We provide exceptional care to you and your family in the comfort of your own home by partnering closely with you and your family and understanding your specific needs.
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Our vision is to create a community where every individual feels valued, supported and cared for as they age gracefully in their own homes. We strive to be the trusted partner for families, setting the standard for...
At T & Z Home Care, we specialize in transportation, disability support, and home care services that make a positive impact on the lives of individuals and families. Our focus is on promoting independence, mobility, and...
At Glory Hands Personal Home Care, we offer compassionate and personalized homecare services. Our dedicated team is committed to enhancing the quality of life for those we serve. We hold their hands, you hold their hearts.
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We Adore You Home Care LLC provides compassionate, reliable non-medical home care services to individuals and families in Indianapolis, Indiana. We are committed to promoting independence, dignity, and comfort through...
Pleasant Place Home Care was founded with a passion for providing high-quality home care personal services to seniors and individuals with disabilities. Our founder, who has over 20 years of experience caregiving,...
FirstLight Home Care of Northern Indianapolis & Suburbs is here to provide companion care and personal care assistance. Our home care and elderly caregiver services are available for elderly individuals, new moms, those...
First Trust Home Care provides compassionate, caring, and personalized in-home care and transportation services for seniors in Indianapolis and the surrounding areas. With a comforting approach and support tailored to...
At Amada Senior Care of Greater Indianapolis, our goal is to walk with seniors and their loved ones through every step of their senior care journey. They are committed to preserving dignity and giving families the peace...
BrightStar Care offers a wide variety of high-quality services—from in-home care to medical staffing. If you are looking for a trustworthy care provider or staffing partner in the Indianapolis NW, IN area, please contact...
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Humble Hearts Home Care provides compassionate, non-medical in-home care designed to support seniors and adults who want to remain safe and comfortable at home.
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...
At Home is Where The Heart Is Homecare our commitment is to transform the way in-home care is experienced by blending compassion, excellence, and truly personalized support. Our mission is to help individuals live safely...
Care When and Where It’s Needed Our home care services are available 24 hours a day, 7 days a week, 365 days a year, so you know your loved one’s needs are always being met. We offer care when and where it’s needed,...
Shalom Care LLC provides compassionate and personalized in-home care services for seniors and individuals with disabilities. Our dedicated caregivers assist with daily tasks, medical support, and companionship, creating a...
A Day After Day Home Care Agency provides exceptional and compassionate in-home care services for all seniors and those who are disabled wanting to age in place. Giving our elders the freedom and independence to remain in...
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Agency Description Kindness Care Solutions, Compassionate In-Home Care Services At Kindness Care Solutions, we are committed to providing high-quality, non-medical in-home care services that prioritize comfort,...
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K&R Glowing Pride Residential Services founded in the year of 2018. operated by Keyana Rice whom worked patient care for the past 17 years. Graduate with honors in Health Science. K&R was established with hope and faith...
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Visiting Angels of Carmel, IN is a home care provider that services in Carmel, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Sim-1 Inspired Home Care Solutions Agency LLC is a compassionate, client-focused healthcare provider dedicated to delivering high-quality, personalized in-home care services.
Care & Companionship Home Services LLC of Carmel, IN is a home care provider that services in Carmel, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
LUXURYTIME PERSONAL CARE LLC is a home care provider that services in Carmel, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
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24/7 Homecare Solutions We treat every client like family, offering compassionate, nurse-led care to seniors across Central Indiana. With round-the-clock support—personal care, companionship, meal prep, medication...
Homewatch CareGivers of Carmel, IN is a home care provider that services in Carmel, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Elroi Care Home LLC offers professional support services that allow individuals to live safely and comfortably in their homes regardless of age, physical, medical or emotional conditions.
HEARTS OF COMPASSION PERSONAL CARE SERVICES LLC is a home care provider that services in Carmel, IN. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Senior Helpers Indianapolis helps families navigate the full continuum of senior care. Our in-home aides allow seniors to receive the day-to-day help with personal care they need and assistance with activities of daily...
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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.