The State of Arizona requires that all placement agencies have their client or clients representative acknowledge that they have received information about how we navigate business with each Group Home, Assisted Living or Independent Living Community that we place clients in. This is only an acknowledgement that we have made this information available to you and in no way obligates you to utilize Aspen Placement Agency.

Disclosure Form

Referral Fee Disclosure

Thank you for choosing Aspen Placement Agency to assist you with choosing an assisted living facility/home. We are required by Arizona law to make the following disclosures to you so that we may receive our fees. Please acknowledge that you have received a copy of this disclosure by filling out the form below.

  1. Aspen Placement Agency is contracted with assisted living facility/homes that it refers to. The assisted living facility/home pays a fee to Aspen Placement Agency in connection with the referral. You or your family are not required to pay any fee to Aspen Placement Agency.

  2. Aspen Placement Agency does not have any common ownership or control of the assisted living facility/home. There is no other financial, business, management, or familial relationship that exists between the referral agency and the assisted living facility/home.

  3. The fee amount is to be paid by the assisted living facility/home to Aspen Placement Agency. The fee amount varies and is dependent on the living arrangements chosen by you. For long-term care the fee is typically between 75%-100% of rent and care for the first month. For short-term care the fee is ⅓ of rent and care for up to three months.

  4. You have the right to terminate our services at any time (including our use of your personal information) through written or electronic notice. If you discontinue our services we will not be entitled to any fee for any move-in you make after the date of termination unless:

    a. The facility/home you move into was one we specifically identified and referred to you after our evaluations and requests, but before we received your notice of termination

    b. You communicate with us before you move into the facility/home.

By filling out the form below, you are electronically acknowledging that you have received this fee disclosure on behalf of the client, all family and loved ones involved in the decision making process. Once submitted, you’ll have the option to download a copy of this fee disclosure.