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:
For 24 years, TheKey has earned the trust of more than 120,000 clients by delivering 12 million hours of personalized home care each year using our science-backed Balanced Care Method® that actively supports well-being....
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...
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We Offer Independence Abiding Care is dedicated to enhancing the lives of seniors, individuals with disabilities, and those who need temporary assistance through our comprehensive home support services, empowering our...
Achieving Friends Home Healthcare Inc. is a compassionate home care provider serving communities across North Carolina. Dedicated to enhancing quality of life, they offer personalized support including personal care,...
At Senior Helpers of Holly Springs, we specialize in providing personalized, non-medical care tailored towards meeting the unique needs of each individual client. Our mission is to foster independence while ensuring...
It doesn’t matter if you’re here because you’re looking for help living independently, or if you want to make sure someone you love has the support they need to stay in their home. We believe there’s more to caring for...
At Senior Helpers, we are here to help anyway we can. No matter how big or how small the task. We are licensed, bonded and insured and have screened and continuously trained caregivers that are immediately available to...
We know there’s no place like home. That’s why HomeWell brings you the highest quality of care so you can maintain your independence and experience life to the fullest.
EBZ Consulting, LLC is a dedicated home care agency committed to delivering compassionate, high-quality, and personalized care to individuals in the comfort of their own homes. We specialize in supporting seniors and...
Licensed for Hands on Care and Companion Services Fully Insured Licensed by the Department of Health and Human Services Division of Health Services Regulation Covering 14 counties out the Raleigh office: Wake, Alamance,...
At Friendly Forever Homecare, we are deeply committed to redefining the standards of care for our clients. Our services cater to individuals’ diverse needs, ensuring that they receive the utmost care, support, and...
A1-Omega Health Services is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
*OOB* SYNERGY HomeCare of Raleigh, NC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Liberty Home Care, Llc is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Whitney Home Care of Raleigh NC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Trinity Staffing, Inc. is licensed by the State of North Carolina to provide in-home care services. Our goal is to help our clients maintain their independence and dignity in the comfort of their own home. Our employees...
Horizons Home Care is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Accessible Home Health Care of Mid Carolina creates a high-quality, safe environment for your loved ones, allowing them to stay in their own home and receive the care they need. Accessible Home Health Care is the...
Arcadia Home Care & Staffing is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Medi Home Health Agency is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
At Griswold Home Care for Raleigh, we offer compassionate in-home care for those who want support to live where they love. With over four decades of experience and a storied legacy of compassion and integrity, we focus on...
Intrepid USA Healthcare Services is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Are You Looking for Peace of Mind Homecare Services for You and/or Your Loved One? Then you look no further!!!ACCESS HOME HEALTHCARE INC (AHHC) is here for you! AHHC Inc. is a Home Care Agency incorporated in the state...
Rex Home Services is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our Family At Elite Care One we are a family oriented Home Care Agency that believes in keeping families together. We believe that people work hard to get a good place to call home so we do everything we can to help you...
At Home Quality Care Inc is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Perpetual Home Care is a NC State licensed home care agency and the only home care agency in the Triangle to be Certified through the Caregiver Quality Assurance program. Our 9 step hiring process offers you and your...
Let us help you understand your home care options, including a full range of integrated care that meets the highest quality standards for compassion and reliability.
SYNERGY HomeCare of North Raleigh is owned and operated by Saveon and Crystal Alston, a newlywed couple with deep bio-pharmaceutical backgrounds who also share a passion for pediatric and geriatric care.
Global Healthcare Resources, Inc. is a licensed Home Care Agency in the State of NC. We play a critical role in caring for seniors and bringing peace of mind to families in need.
Since 1975, Bayada Nurses has helped people have a safe home life with comfort, independence, and dignity. Bayada Nurses provides skilled, rehabilitative, therapeutic, and personal home health care services to children,...
To create a world where individuals facing adversity can find solace, healing, and hope. Our vision is for every person to realize their full potential, reclaim their sense of purpose, and lead fulfilling lives free from...
Above The Horizon Home Care LLC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Ideal Healthcare Services is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Caring Senior Service is a trusted homecare choice for seniors and their families in the area. Read more about our homecare services for this area. Caring Senior Service offers services, education and safety care...
AccordCare - Raleigh, NC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
welcome to First Choice Home Health your first choice in quality home care. We provide one on one in home or in facility care to those requiring specialized help as a result of health issues or specific day...
First Choice Home Health Inc is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Prestigious One Source Home Care is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Americare Alliance of Wake County is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Stay at Home Senior Care and our legacy Family of Providers have had the privilege of serving families and seniors for over twenty years. We have built a network of extraordinary homecare provider agencies that...
Options Home Care of Cary, NC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
Our Story Home—there’s no place like it. It’s where your memories are. Where you raised your family and where friends have gathered for life’s celebrations. It’s been your basecamp through good times and bad. And it’s...
One You Love Homecare Chapel Hill and Raleigh, NC is a home care provider that services in Raleigh, NC. Home care services allow seniors to remain safely in their own home while receiving medical care or assistance with...
From our family to yours, we are not just caregivers, we are an extension of your family. Our One You Love Homecare North Raleigh, North Carolina location delivers senior in-home care to the greater North Raleigh region....
Classic Home Healthcare and Counseling Services is driven by the philosophy of commitment to our patients, leadership and excellence. We recognize the unique physical, emotional and spiritual needs of each person. Our...
Our Services -Companion Care For our basic level of care, caregivers provide services such as companionship, meal planning and preparation, light housekeeping, laundry, medication reminders, and other general assistance....
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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.