Consumer Disclosures Form

Please review the disclosures below. Then copy and paste it into your document application. Or, for your convenience, simply click the button and download the PDF.

General Information for Oregon Consumers

Oregon law requires all long-term care senior living advisors be registered with the Department of Human Services (DHS). The law also mandates the following disclosures be made by each advisor/agency. Accordingly, we disclose the following:

Advisor/Agency Business Information

Business Name: Portland Senior Housing (ABN for Living Right, Inc.)

Registered Advisor: Jennifer Cook-Buman

Telephone: (503) 487-7245



Address: PO Box 534, West Linn, OR 97068

Established: November 2007

Last Form Update: July 2018

Registered Advisor #:  1008

DHS Contact:

Mandated Disclosures

Description of Services to be provided by Portland Senior Housing Agent (PSH)

  • A phone call or e-mail to PSH starts the process.  PSH advisors serve you and/or your designate(s) needing--or simply seeking--information on available long-term care support options. We will ask some general questions about your current situation such as what has happened to inspire your search and then arrange to meet in person to gain greater insight into your needs and desires: Financial, Health, Environment, and Geography will be considered.


  • Our fundamental purpose is to educate, facilitate, guide and support. We are not decision-makers. All decisions are made by you and/or your designate(s). PSH advisors are generalists turning overwhelming amounts of information into useful, time-critical knowledge applicable to your specific circumstances.

We Make Referrals to the Following Types of Senior Living:

  • Adult Foster Homes
  • Assisted Living
  • Independent Retirement Living
  • Residential Care Facilities
  • Memory Care
  • Medicaid Contracted Facilities

Privacy Policy Regarding Client Information:

  • Clients understand and acknowledge that each transition and situation is different and unique. We pledge to maintain your privacy at all times sharing personal information on a “need-to-know” basis only. Your personal information will never be sold for any reason. During our client inquiry process, we will ask you for pertinent health information, your preferences and your available financial resources. At no time will we ask for any banking, investment statements or account numbers. We collect only the necessary information required to make our professional referrals.

Length of Contract:

  • Authorization shall be in force and effect until you terminate this agreement with PSH (via phone call, email, text or written notice) at which time this authorization expires.
  • You understand that you have the right to revoke this authorization at any time.
  • You understand that a revocation is not effective to the extent that any person or entity has already acted in reliance on this authorization, to view your information.

Referral Fees:

  • We are compensated by the providers we contract with. PSH, nor parent company, Living Right, Inc., has NO ownership interest in any care provider business as required by law. PSH is an Oregon-registered business in good standing.

Limitations on Referrals:

  • PSH will contact prospective facilities and arrange for a convenient time for us to tour. This will include options that we are contracted with. Appropriate non-contracted options may also be identified for pursuit on your own. 

Facility Complaint History:

By signing below, I acknowledge I am the client or designate authorized to receive this disclosure document. Concurrently, I authorize the sharing of personal client information as may be required to find satisfactory accommodations and support services.


Receiving Individual - Signature


Receiving Individual - Printed Name



Copyright 2018, Portland Senior Housing