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Senior Companion Care Inquiry Form

At Ludessia, we understand that inviting support into a loved one’s life is a meaningful decision. Our companion care services are designed to provide trusted non-medical support, meaningful connection, and peace of mind for families. Please complete the form below and a member of our team will contact you to discuss your family’s needs.

In-home companion care services for seniors and families in Atlanta Georgia

First name*

Last name*

Email*

Phone*

Address*

County*

Relationship to Client*

What is the client’s first name?*

Age Range of Client*

Where would care be provided?*

Private Home

Apartment/Condo

Independent Living Community

Assisted Living Community

What type of living environment does the client currently reside in?*

Client Lives Alone

Client Lives with Family

Other

What type of support are you seeking?*

Companionship & Social Engagement

Meal Preparation

Light Housekeeping

Medication Reminders

Transportation/Errands

Appointment Accompaniment

Overnight Support

Safety Supervision

Wellness Check-ins

Recovery Support

Family Respite

Other

How often are you seeking care?*

When are you hoping services will begin?*

Immediately

Within 1–2 Weeks

Within 30 Days

Exploring Options

Are there any mobility concerns?*

Mild Assistance Needed

Walker

Wheelchair

Other

Is the client living with memory-related challenges?

Mild Memory Concerns

Alzheimer’s/Dementia

Prefer to Discuss Privately

What qualities are most important in a caregiver?*

Calm Presence

Conversation & Engagement

Patience

Experience with Seniors

Professional Appearance

Warm Personality

Strong Communication

Other

Are there hobbies, routines, or interests the client enjoys?*

How did you hear about Ludessia?

Is there anything else you would like us to know?

I understand that Ludessia provides non-medical companion care services and does not provide medical diagnosis, treatment, or skilled nursing care.

We're here to help. Let's us create the support your need.

Ludessia provides non-medical, in-home support so you and your family can focus on what matters most.

We're here to answer your questions and create a personalized care plan for your recovery.

Stay Connected with Us

Accessibility Statement

smile@ludessia.com

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