This is an editable form that helps people describe what they want in their daily life to feel safe and independent. The form covers many aspects of daily life and can be filled out and changed easily.

To My Caregivers (paid and unpaid) & Family of Choice:
I am recording my personal preferences and information about myself in case I need long-term care services in my home or in a long-term care community in the future.

Please always talk to me about my day-to-day life to see what it is that I want and enjoy.
However, the information below may provide some help in understanding me and in providing my care. I hope this information will be useful to those who assist me.

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