Questionnaire Please provide the following information for us to better serve your love one: Do you have an HCS slot? Do you have an HCS slot? Yes No Name Email Address What town do you prefer to live in? What is your favorite food? What is your favorite drink? What do you like to do? Do you like TV or movies? What is your favorite TV show? What is your favorite color? What makes you feel happy? Help for daily living Help for daily living I need help with my medications I need help with my hygiene I need help dressing I need help walking I need help feeding myself I need help going to the bathroom I need help bathing I need help reading and writing I need help with my money and spending allowance Submit
