All About Me - Harmonious Service Pairing Request
This form is about being able to create a harmonious pairing so that everyone can access their life and services.
Please take your time when completing this. I will use this to interview potential care partners or to reach out to care partners that we already work with.
Client Full Name
Person Completing the form
Street Address Line 2
State / Province
Postal / Zip Code
Please share about the person who needs service. What type of person are they. What do they like or dislike.
Please share about the type of help the person needs to access their life. Such as they take medicine and need help, they need reminders to do things, they need hands on help with eating, etc.
Please share about what services should look like for you. Such as calm and ordered, or more naturalistic, in the home or out and about.
Please share about the type of schedule you need. Days, times, every now and again, or regular.
Please share about how you would describe the ideal care parnter/provider.
Should be Empty: