Monday, May 27, 2024

Download Helpful Forms and Tip Sheets





a picture of a notepad and pen on the tips and forms page for caregiversDownload these pdf files - to save to your computer and/or print out:



None of the assessments below are meant to replace a professional evaluation by a physician or other medical personnel.  These are meant for information and educational purposes only.

Activities Of Daily Living (ADLs):  Assess a loved one's need for more assistance in basic self-care

Independent Activities of Daily Living (IADLs): Assess a loved one's level of independence in general areas of life responsibilities.

Geriatric Mood Scale:  A quiz to assess if there is a potential concern about depression in a senior.  The scale is not a professional evaluation, but rather a way of finding out if there are changes over time or if someone may need more help.

Home Safety Checklist:  A four-page assessment to determine how safe your senior is in his or her home in terms of fall and accident prevention and general security.

Tip Sheets:

Weight Management Tips:  A simple and healthy weight management plan. 

Tough Conversations Worksheet:  A way to organize your thoughts before broaching a touch topic with someone you love.  See more information to go with this sheet here

Chair Exercises for Seniors:  A nice download of chair exercises from the the University of Georgia.  Handy to help Seniors be more active.

Keeping Track of Health:

Medical History Form:  This form is a way to keep track of previous illnesses and other medical information that may be useful for bringing with you to a doctor's office.

Medication Record:  This form should be updated regularly and lists all the medications a person is taking, dosage instructions, etc.  This list should also go with you when visiting physicians and/or the pharmacy.

Notes for Visiting with a Doctor:  This is a listing of questions that you may want to ask your doctor especially if you have recently been diagnosed with an ongoing illness that will require home maintenance.  There are spaces to write down the answers as well.

Healthcare Providers:  This is a listing of all the medical professionals involved in someone's care.

Health Insurance Information:  A form to list all insurance information

Staying Organized:

Document Locator:  This form is a way to begin helping someone get his or her affairs in order.  You can use this for yourself or a loved one.  It lists where all your important papers are in the event that someone else may have to manage things if you or someone you love becomes hospitalized or face a long illness.

Monthly Budget:  This is basic budget form designed as a way to help someone figure out monthly expenses and income.

Refridgerator List:  Download this document, fill it out and place in an obvious place (like the refrigerator!) so that all of his or her important contacts are in one place and easy to find. 

Jobs Checklist:  This form lists typical caregiving tasks and can be used if you are managing a lot of helpers or even be used as a way to start a conversation with other family members about what help you may need.

Guided Visualizations For Relaxation:

20-Minute Guided Meditation for Relaxation:  Listen through your computer or save to your computer to download to a portable device

20-Minute Guided Meditation for Sleep:  Same as the one above, but allows you to use it for aid in falling asleep at the end rather than guiding you to awaken.

Senior Health


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