E-Signature Authorization Statement
I hereby consent and acknowledge that:
- SeniorLiving.net (SLN) may provide disclosures required by law electronically.
- My electronic signature constitutes the same official authorization as a printed document with my written signature. Unless I withdraw my authorization by the process below, my electronic signature applies to these Disclosures now and in the future
- A printed copy of this agreement was available for my review and printing.
Welcome Information, Services Description, & Disclosure Statement
Date: <Insert Date>
Welcome <insert First Name, Last Name>,
Welcome to SeniorLiving.Net! Our local Care Advisor network is ready to assist you with your search for Senior Care services throughout the State of Washington. We are proud to offer you our services and greatly appreciate the opportunity to work with you and/or your loved one.
Our Free Service
SeniorLiving.net is a free information resource for individuals seeking senior housing and care services. We provide you with information about one or more of our Partner Communities and, with your authorization, forward your information to Partner Communities that appear to meet your stated needs and preferences. The Partner Communities will then contact you regarding their facility and/or services. To work on your behalf, we are required to obtain your authorization to obtain confidential health care information relating to you and/or the senior you are seeking care services on behalf of. This authorization allows us to share your information (or information about loved ones) with our Partner Communities.
- Our Care Advisor will work with you to identify personal needs and preferences, medical history and care requirements, financial parameters, and other relevant information pertaining to your search for senior housing and care services.
- Based on the unique personal requirements, our Care Advisor typically will identify local options based on your preferred location, care and budget needs.
- Our Care Advisor will provide you with a list of the locations and contact information for each community. We also provide your contact information to the community to facilitate questions and follow up.
- Care Advisors are available to answer any of your questions throughout the research process or to set up community tours.
SeniorLiving.Net does not charge families for our services. SeniorLiving.Net, in some cases, is paid a referral fee by the Partner Communities. Partner Communities pay SLN a percentage of the monthly rent and care they receive. The total amount of fees does not exceed one full month’s rent and care charges. We invoice these fees after the senior moves in, and they do not impact the cost of rent or care charges charged by the Partner Community. We prohibit our partners from passing the cost of our fees onto families.
SeniorLiving.Net requires our Partner Communities to comply with local laws and be licensed in the State of Washington. For your protection, every 30 days, SeniorLiving.Net reviews each community we work with on the Washington State Department of Social and Health Services (DSHS) and Department of Health (DOH) websites to determine if a Partner Community has violated any state or federal licensing requirements. SeniorLiving.Net will provide a link to these enforcement statuses for your review.
DSHS and DOH are solely responsible for the enforcement of state laws and updating information on their website. SeniorLiving.Net is not responsible for the timeliness and accuracy of this information. The DSHS and DOH maintain records back to April, 2010. We encourage families to request copies of each community’s most recent state survey to factor that into their research and evaluation process.
Tours of Partner Communities.
SLN tours certain Partner Communities; however, we do not currently have a set touring frequency for all of our Partner Communities. When we provide you information on a Partner Community we will include in email the dates when we last toured the community.
You are under no obligation to use our service or move into a Partner Community. At any time you may use another service or no service at all in your process to find care. As SLN is a completely free service to families, there will never be a need to require a refund from us. Your SLN Care Advisor is a resource to assist you in your search.
No Waiver of Rights
At no time will SLN request or require that you sign waivers of liability for potential losses of personal property or injury, or to sign waivers of any rights established pursuant to state or federal law.
Your Feedback is Important to Us.
Improving families’ search experience for senior housing and/or care services is our mission. If you ever have questions, comments, or complaints about our service, please let us know. Our Customer Service team can be reached via phone at 877-345-1706 or via email at email@example.com. We really do appreciate your feedback, which we will use to continuously improve the experience we provide to our families.
Additionally, 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 in person or via mail at Consumer Protection Division, 800 5th Avenue, Suite 2000, Seattle, WA 98104, or via phone at 800-551-4636.
SeniorLiving.net (A Place for Mom, Inc.)