Partnership Agreement

Portland Senior Housing

(503) 487-7245

​​​PO Box 534, West Linn, OR 97068

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

Our goal is to help clients make the best decision for their situation regarding senior housing and care options.  In order to achieve this goal, it is important we work honestly and openly together.  How we conduct business is outlined below. Your signature acknowledges that you understand and agree to these terms and conditions. Thank you. 

The Agreement

1. A phone call or e-mail to Portland Senior Housing starts the process.  A consultant will call you and ask details about your current situation. 

2. Health and financial considerations are discussed confidentially during this initial meeting. We will discuss which options want to be considered, and based on information and research decide which of them will be investigated. If the resident/representative has contacted facilities or another agency within the past 6 months it is important for Portland Senior Housing to be told this information.

3. Portland Senior Housing 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.  

The type of referral(s) being provided to you include, but not limited to the following

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

4. The decision regarding facility choice is that of the resident/representative. Portland Senior Housing’s role is that of a consultant. We will assist with helping the resident/representative ask questions and discerning information, but the final choice is that of the resident or their representative.

5. When a choice is made, financial and move-in procedures will be discussed with the community. Health and financial information will be requested by the housing provider. A health assessment which includes contact names and numbers, medical information, and necessary care must be conducted before moving into a licensed facility to comply with state regulations for the facility.

6. Payment to “Portland Senior Housing Senior Placement” for services is provided through an existing contract with the senior living facilities.

7. Authorization shall be in force and effect until you terminate this agreement with Portland Senior Housing, Inc., (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.

8By signing this, you are authorizing the Portland Senior Housing consultant to collect and share information from your healthcare providers and any case managers working with the subject person as it relates to identifying satisfactory accommodations and services. You understand that information used or disclosed pursuant to this authorization is no longer protected by federal or state law.


Signature of patient or legal personal representative.                         


Printed name of patient or legal personal representative. 



Copyright 2018, Portland Senior Housing