Localposh Healthcare Partnership Inquiry
Submit this form if you represent a healthcare organization interested in partnering with Localposh for companion care, dementia support, tele-health facilitation, respite care services or other in-home support services.
Contact Information
Please provide your contact details so we can follow up regarding partnership opportunities.
Full Name
*
First Name
Last Name
Title / Role
*
Organization Name
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City
State
Preferred contact method
*
Phone
Email
Video call
Organization Information
Tell us more about your organization.
Organization Type
*
Health system
Physician group
Home health agency
Care management organization
Senior living community
Medicare GUIDE participant
Value-based care organization (ACOs, insurers, and providers)
Other
Primary services your organization provides
*
Dementia care
Primary care
Home health services
Care coordination
Behavioral health
Telehealth
Geriatric care
Other
States or regions served
*
Partnership Interest
Let us know how you'd like to partner with Localposh.
What type of partnership are you interested in?
*
Referring patients for respite care
Care delivery partnership
Value-based care support
Dementia support services
Medicare GUIDE program support
Pilot program collaboration
Other
Estimated monthly patient referrals
1–10
10–50
50–100
100+
Program Details
Share any current program participation.
Are you currently participating in any of the following?
Medicare GUIDE Model
Value-based care program
Dementia care initiative
Caregiver support program
None of the above
Additional Information
Tell us more about your program and partnership vision.
Tell us about your program and how you envision partnering with Localposh.
Submit Inquiry
Should be Empty: