Get steady dementia support — before the crisis.

Tell us about your family and we'll connect you with a dedicated care concierge — at no cost through the Medicare GUIDE program.

Complete this short form and our care concierge team will reach out within one business day.

Complete this form to connect with trusted senior companions and respite caregivers through Localposh.

Tell us about yourself so we can reach you regarding care for your loved one.

Your Full Name
- First Name
- Last Name
Your Email Address
example@example.com
Your Phone Number
Please enter a valid phone number. Format: (000) 000-0000.
Preferred Contact Method
Phone / Text / Email
Your relationship to the person needing care
Spouse / Adult child / Family member / Friend / Care manager / Other

Tell us about the person who will receive care.

Loved One's Complete Name
Date of Birth (XX/XX/XXXX)
Age of the person needing care
Street Address
City
State
Zip Code
Current living situation
Lives alone / Lives with family / Assisted living / Memory care community / Other

Help us understand the type of care and support your loved one needs.

What type of support are you looking for? (Select all that apply)
Companionship / Dementia / Alzheimer’s support / Respite care for a caregiver / Transportation to appointments / Meal preparation / Help around the home / Post-hospital support / Safety supervision / Other
Primary health concerns (optional)
Dementia or Alzheimer’s / Cognitive decline / Fall risk / Mobility limitations / Loneliness or isolation / Post-hospital recovery / Other
Mobility level
Fully mobile / Uses cane / Uses walker / Wheelchair / Limited mobility
Does your loved one require supervision for safety?
Yes / No / Sometimes

Let us know your preferences for scheduling care.

How many hours of care are you looking for?
4-hour visits / 8-hour visits / Overnight support / Flexible schedule
Preferred schedule
Weekdays / Evenings / Weekends / Flexible
When would you like care to begin?
Immediately / Within 1–2 weeks / Within a month / Just exploring options

Share anything else that would help us understand your loved one's needs.

Is there anything else you would like us to know about your loved one's needs?
How did you hear about Localposh?
Healthcare provider / Hospital or clinic / Google search / Friend or family / Community organization / Social media / Other

I agree to be contacted by Localposh regarding care services. * REQUIRED

What Your Family Gets

Localposh coordinates everything so you don't carry it alone.

A dedicated concierge aligns your care team — providers, aides, and family — so nothing falls through the cracks.

Every care partner is background-checked, trained in dementia support, and matched to your family's needs.

Scheduled relief so caregivers can rest, recharge, and take care of themselves too.

Enrolled families pay nothing out of pocket. Localposh is covered through the Medicare GUIDE Model.