🌟 Golden Glow Visits – Client Interests & Life Story Form
This form is designed to help us get to know you or your loved one better beyond health needs. The information you share will allow us to plan activities, conversations, and visits that reflect personal history, preferences, and joys. Our goal is to build meaningful connections, honor your story, and create visits that feel engaging and familiar.
Name
First Name
Last Name
Preferred Name / Nickname
Place of Birth & Childhood Hometown
Work History
Military Service (Yes/No; branch, role if applicable)
Religious or Spiritual Preference (optional)
Languages Spoken
Marital Status / Spouse Name (if applicable)
Children (Names, Ages, and where they live now)
Grandchildren or Great-Grandchildren (optional)
Pets (current or past, type, names)
Close Friends / Support System
Morning Routine (what time do they usually wake up, morning habits)
Evening Routine (bedtime, favorite nightly activity, TV shows, reading, prayers, etc.)
Favorite Meals or Snacks
Coffee/Tea Preferences
Dietary Restrictions / Preferences (vegetarian, diabetic, low-salt, etc.)
Favorite Music (artists, genres, songs for sing-alongs)
Favorite Books / Authors
Favorite Movies / TV Shows
Hobbies (crafts, puzzles, gardening, knitting, card games, etc.)
Outdoor Activities Enjoyed (walking, birdwatching, sitting outside, gardening)
Social Activities Enjoyed (church, clubs, bingo, group games)
Favorite Vacation or Travel Destination
Special Holiday Traditions
Fun Fact or “Something Unique” About Them
Biggest Accomplishment / Proud Moment
Something That Always Brings Them Joy
Things they hate
Preferred Activities During Visits
Conversation & Storytelling
Reading Together (newspaper, Bible, books)
Listening to Music / Singing Together
Arts & Crafts
Puzzles / Games / Brain Teasers
Walking / Light Exercise
Outings (stores, cafes, events)
Pet Interaction
Baking / Cooking Assistance
Technology Help (using phone, video calls, etc.)
Other
Submit
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