I/We authorize Huntsville Senior Placement Advisory LLC to share the information gathered in this assessment with senior living facilities for the purpose of evaluating placement suitability. I/We understand that this information will be shared only with facilities that are being considered for placement and will be kept confidential in accordance with applicable privacy laws.
I/We acknowledge and understand the following:
1. Free Service: Huntsville Senior Placement Advisory LLC provides this placement advisory service at no cost to me/us or the prospective resident.
2. Compensation Disclosure: The Advisor receives a referral fee from the senior living facility upon successful placement. This fee is paid by the facility, not by me/us or the resident.
3. Independence: The Advisor has no ownership interest, financial control, or managerial relationship with any facility recommended, other than the referral fee arrangement.
4. No Obligation: I/We are under no obligation to choose any facility recommended by the Advisor. I/We are free to contact facilities directly, use other advisory services, or make our own arrangements at any time.
5. Not a Medical Evaluation: This assessment is for referral purposes only and does not constitute a medical, neuropsychological, or financial evaluation. The facility selected will conduct its own formal assessment before admission.
6. No Guarantee: The Advisor does not guarantee admission to any facility, the quality of care provided by any facility, or eligibility for Medicare, Medicaid, or any other benefits program.
I have conducted this assessment in accordance with the standard operating procedures of Huntsville Senior Placement Advisory LLC. I have provided the client/family with a full disclosure of our services and compensation structure. I will use the information gathered to identify the most appropriate care level and facility options for the prospective resident.
