carecodeform – Enrichment on Demand

Help us to build a great day!

We need to know what you know

At Enrichment on Demand we understand how important these details are to the care and wellness of those enduring dementia. As preferences evolve, this form can be used as often as necessary to keep the details needed by caregivers up to date and at their fingertips.

Apartment no.

Featured person (first name only):

Email address of person submitting information:

Community name:

The most important thing to know:

Things to avoid:

Tips for helping to redirect when needed:

Conversation starters: Three things to ask me

Typical daily routine:

Food likes/dislikes/snacks

Beverage preferences:

Favorite activities:

Favorite music genres/performers:

Television viewing:

Grooming

Clothing/laundry:

Family details:

Cultural/religious traditions:

Education/career:

Other helpful information:

Music:

1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s Jazz Classic Rock Soft Rock Broadway Big Bands Country western Spiritual Calming Latin Opera Rhyhm/Blues Electronic Disco

Hobbies:

Painting Drawing Gardening Quilting Fishing Travel Hiking Cooking Animals Cars Dancing

Movies

Action/spy Comedy Westerns Drama Documentaries Historical Romance Hallmark Mysteries Biographical

Classic Television

1950s 1960s 1970s 1980s 1990s Variety shows Westerns Mysteries Detective shows

Virtual Tavel

National parks US Landmarks Tropical beaches World travel Europe Asia South America Asia Alaska Hawaii

Relaxation

Ocean waves Rain Bird watching Guided meditation Tropical fish

Please write a short bio of the life events you would like to share: (optional)

Upload a photo (optional)

Help us to build a great day!

We need to know what you know

At Enrichment on Demand we understand how important these details are to the care and wellness of those enduring dementia. As preferences evolve, this form can be used as often as necessary to keep the details needed by caregivers up to date and at their fingertips.

enrichment on demand

480.223.8114

email