Resident Life Story and Biography Intake

A long-form biographical intake form for senior living communities to capture a resident’s life story, personal history, preferences, family background, milestones, and legacy details for care planning and engagement.

Introduction and Consent

• Consent to collect and use this biographical information for resident care and engagement
  By checking this box, you confirm that the information provided may be used by the care team for resident-centered activities, care planning, and family engagement.
• Your relationship to the resident
• Your name
• Your email address
  Optional. Used only if we need to follow up about missing or unclear information.

Resident Basic Details

• Resident full name
• Preferred name or nickname
• Date of birth
  Optional. Only provide if needed for identity matching or care coordination.
• Place of birth
• Current room or unit
  Optional. Helps staff connect the biography to the resident record.

Childhood and Early Life

• Describe the home or neighborhood where you grew up
• Parents or guardians
  Include names or roles only if you are comfortable sharing them.
• Siblings
  List names, birth order, or a brief description of sibling relationships.
• Favorite childhood memories
• Any early life challenges or important events
  Optional. Share only what you want the care team to know.

Education and Work History

• Education history
• Career or work history
• Proudest achievements
• Military service or public service
  Optional. Include branch, role, or service highlights if relevant.

Family, Relationships, and Community

• Spouse or partner
• Children
  Include names and any relationship details you want staff to know.
• Grandchildren or other important family members
• Close friends or support people
  Optional. Useful for visits, calls, and care coordination.
• Community, faith, or volunteer involvement

Interests, Preferences, and Daily Life

• Hobbies and interests
• Favorite music, artists, or genres
• Favorite foods or beverages
• Daily routine preferences
• Preferred way to communicate

Legacy, Values, and Final Notes

• Values, beliefs, or guiding principles
• Important life lessons or advice you would like remembered
• Message you would like family or staff to remember
• Anything else we should know
  Optional. Please avoid including sensitive medical details unless they are necessary for care and you consent to sharing them.