This form will help us learn a little bit more about your loved one and what is important to them. By sharing this information we hope to make their stay with us more comfortable and less stressful
My Name is:
and I like to be called:
I was born and grew up in:
The people who are important to me are:
Equipment I need (Glasses, Walking Stick etc.):
How I like my hot drink:
Signs that I may be in pain or discomfort
Things I Like:
Things that help me settle and relax:
Things I dislike:
Things that make me upset:
Things I may need help with:
Anything else we need to know
Please hand this form to a member of staff once completed.
