HD Helpful Forms
On-Line Forms Available


Index Page
HDSA Team HOPE~Walking For HD
Things For Caretakers To Remember
Download Word Documents
Personal Emergency Information
Medication & OTC Form
Personal Health History
On-Line Forms Available
Caregiver Daily Instructions-Page 1
Caregiver Daily Instructions-Page 2
Instructions-Appointment Schedule
Instructions-Daily Hygiene Schedule
Instructions-Daily Meal & Snack Schedule
Instructions-Daily TV Schedule
Instructions-Household Appliances
Appointments & Follow Up List
Letter to Doctor-Medications
Top 3 Things To Discuss With Doctor
Question List To Give To Doctor(s)
Picture Cards
For "Absent Friends"

Index Page

The following forms are available from Family Care America, one of the most trusted sources of information and resources for caregivers of the elderly, disabled, and chronically ill.  These forms
are linked here for your convenience and use.
Please visit their site at www.familycareamerica.com because there is a LOT more excellent information there to help you,including finding resources by your zip code!
Physical & Emotional Health
Appointment Information
Use this form to keep track of your loved ones medical appointments.
Use copies of this form to monitor daily changes and help with communication among care providers working in shifts.
Choosing A Rehabilitation Program
A list of questions to consider as you and your loved one
prepare to choose a rehabilitation program.
Choosing the Right Doctor
Consider the following questions and steps as you and your
loved one evaluate physicians.
Keeping Track Of Side Effects
A form to help you chart eating-related side effects

Making a Personal Medical History Chart
A sample chart to help you document your loved one's
medical history.
Weekly Medicine Chart
Use this form to help your loved one keep track of his or
her medications.
Weekly Rehab Calendar
A form to help you and your loved one track his or her
rehabilitation goals and successes.
Planning & Assessment
Caregiving Decision Questionaire
A brief list of questions to help you set prioities and solve caregiving
Driving Assessment Checklist
If you are unsure about your loved ones ability to drive, this checklist
can help
Needs Assessment Worksheet
This worksheet will help you and other family members determine what
types of assistance your loved one needs.
Net Worth Calculation Worksheet
A form to help you assess your loved ones financial situation.
Social Service Checklist
Use this form to keep a record of in-person and phone interviews with
social service agencies.

Record Keeping & Legal Matters

Caregivers Document Organizer
A form that will help you identify, locate, and organize the i
mportant documents your will need as a primary caregiver.
Caregivers Journal
Some tips for setting up a notebook to keep track of your
caregiving situation.
Personal Records
A form to help you keep track of your loved ones personal records
and other important information.
Sample Filing System
Listed below is one possible method for setting up a home filing
system. You should adopt a system that fits your needs and those of your family.
Your Valuable Records
A form to help you keep track of all of your familys valuable records.


Assisted Living: Costs And Contracts
A list of financial questions to ask when you and your loved
one visit an assisted living facility.
Assisted Living: Personal Care
A checklist of personal and health care questions to ask
when you and your loved one visit an assisted living facility.
Assisted Living: Quality Of Life
A checklist of questions dealing with socializing, meals,
safety, and other issues to consider when you and your loved one visit an assisted living facility.
Assisted Living: Special Care Units
If your loved one is considering a move to assisted living,
you need to find out about any special care services offered by the facility.
Continuing Care Questionnaire
A list of questions to ask when you and your loved one visit
a continuing care retirement community.
Home Modification Checklist
How to safety-proof a loved ones home.
Nursing Home Checklist
A list of basic questions to ask when you and your
loved one visit a nursing home.
Questions About Hospice Care
A checklist of questions to ask as you try to find the right
hospice service for your loved one.
End of Life
Are You Grieving?
A checklist of the physical, mental, and behavioral symptoms of grief.
Funeral Planning Checklist
A list of all of the issues to consider when planning a funeral.
Funeral Planning Form
As your loved one makes his or her funeral plans, use this form
to record all of his or her wishes for final arrangements.
Funeral Planning: Personal Information
A form to help you record important personal information for use
in planning a funeral, informing friends and relatives, and writing an obituary.