Emergency Information Form for Senior Care

Essential emergency information form for seniors

emergency care for seniors

Caregiver emergency information form template

10 page caregiver emergency form designed for families who have a senior loved one in mind, for private caregivers, or home care companies. This form can also be used as a general assessment form for senior care providers..

What does this form cover?

It Includes all emergency and non emergency contact information needed, including senior’s name, address, phone number, blood type, disease/all those conditions, any allergies, medications, hygiene routines, mobility aids, regular Doctors, Specialists, home environment, Social workers and much more. This form also provides contact information for other family members, friends and neighbors.

Senior Care Information Form Template-preview

Senior Care Information Form Template-preview-zoom

senior fall

Prepare ahead of time for any potential falls

Remember to post Emergency numbers – 911, police, fire department and local hospitals and house fire escape plan on the wall where the senior lives, and place in an obvious spot where anyone entering the home to provide care can see right away in plain view.

senior care information form template

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Before you download the single template have a look at our packages

If you plan to start, or currently operate a senior care business…

(Senior Care Information Form Included in Pack)

senior care business templates-feature image-wise caregiving

Templates Included:

  • Senior information form
  • Fall risk assessment tool 
  • Senior care quote template
  • Caregiver job description template
  • Terms of senior care service agreement
  • Daily senior care journal
  • Housekeeping checklist
  • Personal hygiene chart
  • Senior care invoice 
  • Tax receipt for senior care services
  • Hire a caregiver checklist
  • Application form
  • Pre-interview questionnaire
  • Caregiver interview questionnaire
  • Reference check questionnaire
  • Caregiver employment agreement (long form)
  • Caregiver employment contract (short form)
  • Caregiver job post sample
  • COVID-19 Screening caregiver form for visitors 🆕

Both the word documents as well as the Excel spreadsheets can be altered, added too or parts removed. Please do not hesitate to reach out if you need assistance with any of our forms or excel formulas. 

*All documents and forms can be form filled digitally, and printed.

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If you plan to hire a caregiver …

(Senior Care Information Form Included in Pack)

Hire a private caregiver guide and templates-wise caregiving

This ‘digital’ guide book, will take you quickly through each necessary steps to find, screen, and employ quality caregivers. 

The guide includes 16 templates, forms, and agreements in the download. These templates will keep you organized and protected by having everything in writing. The ‘hire a private caregiver template pack’ is a wonderful tool if you are new to this process. It is also useful if you are going through a negative experience finding the right caregiver for your senior loved one(s). Our aim is to help you find a quality caregiver that is kind, patient, and committed.

HIRE A PRIVATE CAREGIVER CHECKLIST (use for each caregiver candidate)
CAREGIVER JOB DESCRIPTION (job expectations in writing)
SENIOR CARE INFORMATION FORM (use for emergency purpose too)
YEARLY TAX RECEIPT FOR SENIOR CARE (give to caregiver to fill out)
DAILY SENIOR CARE JOURNAL (have caregiver fill out after each visit)
PERSONAL HYGIENE CHART FOR SENIOR CARE (important when more than one caregiver is involved)
PRE-INTERVIEW QUESTIONNAIRE (send via email for pre-screening)
CAREGIVER INTERVIEW QUESTIONNAIRE (full in person/virtual meeting)
SAMPLE JOB POSTING TEMPLATE (ideas for your job post)
COVID-19 SCREENING CAREGIVER FORM TEMPLATE (fill out upon entry to senior’s place of residence)

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