Home Care Match

Need help locating the appropriate home care services for your loved one? CarePathways has formed a partnership with ElderCareLink to provide our visitors a totally FREE home care referral service.

Within minutes of completing the brief survey below; you will receive a detailed email listing care providers in your area who match your specific requirements. If you include your phone number, you will also receive follow-up calls from those providers (We recommend that you include your phone number). Last year alone, over 100,000 families utilized this service in their search for high-quality senior care. This service is a valuable enhancement to our directory. Let us assist you.

Contact Information
Please provide the following information for the person completing the needs survey and requesting results.

Salutation:
First Name:	**
Last Name:	**
Primary Phone:	- - Ext.
Secondary Phone:	- - Ext.
Email:	**
Zip Code:	**
Best time to call:

Service Location
Please provide the location where the service(s) will be required:

City:

State:

Zip:

Services Required
Please select any services that you believe are required for the Care Recipient:
(Please select all that apply)

Funding
What funding source will be the primary payer for the services or products?

Private pay	Medicaid / Public Assistance
Medicare	Long Term Care Insurance
Combination (Private Pay & Medicare)

Budget
How much have you budgeted for these "out-of-pocket" expenses?

Less than $250 per week	$1,000 to $1,500 per week
$250 to $500 per week	Over $1,500 per week
$500 to $1,000 per week

Terms of Use (Accept by checkmarking box)

Please conform that you have read and accept the attached Terms of Use and hereby authorize LongRun Strategies LLC ("LongRun"), or any other party operating the ElderCarelink.com site on behalf of LongRun, to submit and share information I have posted on the Site through the needs survey and/or other means to any contracted provider in accordance with the Terms of Use. I recognize that I have been informed through the Terms of Use of all disclosures required by law regarding the business relationship between ElderCarelink and its participating providers. I further acknowledge that this authorization will remain effective unless I notify LongRun in writing of the revocation of this Authorization Statement at the address given in the Terms of Use. I further acknowledge that the information provided by me is accurate and complete.

THE FOLLOWING DESCRIBES THE TERMS ON WHICH YOU MAY BE PROVIDED ACCESS TO ElderCarelink.com. BY ACCESSING THIS SITE YOU AGREE TO BE BOUND BY THESE TERMS OF USE.

ElderCarelink.com (the "Site") is owned and operated by LongRun Strategies, LLC; a Massachusetts limited liability company ("LongRun"). LongRun may amend this Agreement at any time by posting amended terms and conditions on the Site.

1. THE SITE. The Site offers a lead generation service that matches requests from potential customers ("You" or "Users") with providers who offer financial, medical, healthcare and other products or services ("Providers") that may be able to meet Users' needs. LongRun is not involved in the actual transaction between Users and Providers and does not promote or recommend any particular Provider. Consequently, LongRun cannot ensure that a transaction will occur or if it does occur that it will satisfy the needs of either Providers or Users. The Site acts as the venue for Users to submit requests to Providers who are clients of LongRun, and the information you provide to us will be sent to Providers in our network. The Site does not dispense medical advice. All charges associated with this service are incurred by the Providers. All rights relating to the Site, including ownership as to content, materials, trademarks and other intellectual property contained in the Site, are the exclusive property of LongRun and You may not copy, reproduce, publish, disassemble, decompile, modify or make any other use of the Site or content contained therein other than as expressly provided hereunder or as may be expressly permitted by LongRun in writing. The Site may contain links to other websites owned or operated by third parties. LongRun has no responsibility, obligation or liability with respect to such third party sites and makes no warranties with respect to such sites and You access them at your own risk.

2. CONDUCT. You are responsible for maintaining the accuracy and sufficiency of information You supply to the site and agree to provide and maintain true, complete and correct information on the Site. You may not use the Site in violation of any applicable law, in violation of the intellectual property rights of others or to transmit harmful, threatening, obscene or other objectionable material. You may not allow anyone else to use Your email address or access the Site using your email address. You agree to notify LongRun immediately of any unauthorized use of your email or any other suspected breach of security as to the Site. You acknowledge that LongRun screens information Users provide to the Site and may in its discretion remove any content or terminate your right to use the Site at any time for any reason. You authorize LongRun to provide information You post to the Site to Providers for the purpose of matching your request with the services of Providers by accessing and completing the User Authorization Statement. Such authorization shall continue in effect until LongRun receives written direction from You to cease providing such information to Providers.

3. PRIVACY. LongRun will only use Your Information in accordance with our Privacy Policy and will notify Providers who use Your information and any other organizations to whom You authorize release of your information to use it in accordance with our Privacy Policy. For more information, see our full Privacy Policy.

4. RELEASE. You release LongRun (and its officers, directors, agents, and employees) from claims, demands, and damages (actual or consequential) of every kind and nature, known and unknown, suspected and unsuspected, disclosed and undisclosed, arising out of or in any way connected with any dispute You may have with any Provider.

5. INDEMNITY. You agree to indemnify and hold LongRun, its parents, subsidiaries, affiliates, officers, employees and partners, harmless from any claim or demand, including reasonable attorneys' fees, made by any third party due to or arising from your use of the Site, your purchase or use of products or services offered by the Providers, the violation of this Agreement by You, or the infringement by You, or any third party using your account, of any intellectual property or other right of any person or entity.

6. WARRANTY DISCLAIMER. You use the Site at your own risk. THE SITE IS PROVIDED ON AN "AS IS, AS AVAILABLE" BASIS. NEITHER LONGRUN NOR ANY OF ITS EMPLOYEES, OFFICERS OR DIRECTORS, MAKES ANY WARRANTIES, EXPRESS OR IMPLIED, WITH RESPECT TO THE SITE, SERVICES PROVIDED BY THE SITE OR ANY CONTENT OR PRODUCTS, AND HEREBY DISCLAIMS ANY IMPLIED WARRANTIES, INCLUDING, WITHOUT LIMITATION, THOSE OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NON-INFRINGEMENT. YOU ACKNOWLEDGE THAT USE OF THE INTERNET INVOLVES INHERENT RISKS BEYOND THE CONTROL OF LONGRUN AND LONGRUN CANNOT ASSURE THE INTEGRITY, PRIVACY OR RESTRICTED ACCESS TO INFORMATION WHICH YOU POST TO THE SITE. Some states do not allow the disclaimer of implied warranties, so the above limitations may not apply to You.

7. LIMITATION OF LIABILITY. IN NO EVENT SHALL LONGRUN OR ITS EMPLOYEES, OFFICERS OR DIRECTORS BE LIABLE FOR LOST PROFITS OR ANY SPECIAL, INCIDENTAL, INDIRECT, PUNITIVE OR CONSEQUENTIAL DAMAGES ARISING OUT OF OR IN CONNECTION WITH THE SITE, THE USE OR THE INABILITY TO USE THE SITE OR THIS AGREEMENT (HOWEVER ARISING, INCLUDING NEGLIGENCE). LONGRUN'S LIABILITY, TO YOU OR ANY THIRD PARTIES IN ANY CIRCUMSTANCE IS LIMITED TO THE AMOUNT OF FEES YOU PAY US IN THE TWELVE MONTHS PRIOR TO THE DATE THE CAUSE OF ACTION AROSE. Some states do not allow the exclusion or limitation of incidental or consequential damages, so the above limitation and exclusions may not apply to You.

8. GENERAL. This agreement constitutes the entire agreements between You and LongRun. The rights and obligations of the parties under this Agreement shall be governed in all respects by the laws of The Commonwealth of Massachusetts without regard to its conflict of law provisions and all disputes shall be subject to the exclusive jurisdiction of the courts of The Commonwealth of Massachusetts or the federal courts sitting in The Commonwealth of Massachusetts and You hereby consent to such exclusive and personal jurisdiction and venue. If any provision of this Agreement is found to be unenforceable or invalid, that provision shall be limited or eliminated to the minimum extent necessary so that this Agreement shall otherwise remain in full force and effect and enforceable. This Agreement is not assignable, transferable or sublicensable by You without LongRun's prior written consent. LongRun may assign this Agreement in whole or in part. No agency, partnership, joint venture, or employment is created as a result of this Agreement and You do not have any authority of any kind to bind LongRun in any respect whatsoever. Headings are for convenience only and have no legal or contractual effect. All notices under this Agreement shall be in writing and shall be deemed to have been duly given when receipt is electronically confirmed, if transmitted by facsimile or email or upon receipt, if sent by certified or registered mail, return receipt requested. ElderCarelink.com and the content contained therein is copyrighted by LongRun and the marks and designs of the Site are trademarks or service marks of LongRun or its clients. All rights reserved.

9. CONTACT INFORMATION. If You have any questions or need further information as to the Site or services provided by LongRun, or need to notify LongRun as to any matters relating to the Site please contact ElderCarelink at:

ElderCarelink
190 Front Street
Suite 201 
Ashland, MA 01721

Or via

Email to: contactus@ElderCarelink.com

10. REQUIRED DISCLOSURES. You acknowledge and certify that LongRun has made the following disclosures to You throughout this website: The manner in which LongRun selects its group of Providers to which it could make a referral; The fact that the Provider has paid or will pay a fee to LongRun; The manner in which LongRun selects a particular Provider for you from its Provider Group; The nature of the relationship between the referral services and the group of providers to whom LongRun can make the referral; and The nature of any restrictions that could exclude such an individual or entity from continuing as a Provider.

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