Personal History Booklet

How to use this booklet

Sit with your loved one for 30 minutes with this printed out. Write in their words, not yours. Include stories, not just facts. Add photos where you can — printed 3″×5″ is fine. Give a copy to every caregiver who works with your loved one, and keep the original in a bedside binder.

Section 1 — Name and identity

Preferred name (what people who love them call them)
Full name
Date of birth
Place of birth
Languages spoken (in order of preference / childhood language first)
Religion or faith practice
Ethnic and cultural background they identify with

Section 2 — Family

Spouse (living / deceased, name, years married, where met)
Children (names, birth years, where they live now)
Grandchildren (names, ages)
Great-grandchildren
Siblings (names, alive / deceased)
Parents (names, where they were from)
Family members the person mentions often
Family members it upsets them to be reminded of (grief, estrangement)

Section 3 — Places

Places they lived over the years (with rough years)
Neighbourhood or city they identify most with
Vacation spots they loved
Their favourite place in the current home
Places to never take them (bad memories, phobias)

Section 4 — Work and skills

Career or careers (with years)
Skills they were proud of
Awards or achievements
Military service (branch, years, deployment)
Volunteer work
Community roles they held

Section 5 — Hobbies and interests

Hobbies (past and current — even if they no longer do them, they may light up talking about them)
Sports they followed (team by team)
Music they love (genres, specific artists, favourite songs — please note era, generally age 15–25 music resonates most in later dementia)
TV shows and movies they know well
Books or authors they loved
Pets they have loved (names, breeds)

Section 6 — Daily routine

Wake time and morning ritual
Preferred breakfast (specific — “two eggs over easy, whole wheat toast, orange juice” not “a good breakfast”)
Morning activities
Lunch preferences
Afternoon routine
Dinner preferences
Evening ritual (TV show, glass of wine, prayer, bath)
Bedtime routine
Overnight patterns (any bathroom trips, any snacking)

Section 7 — Food and drink

Favourite foods
Foods they refuse
Cultural or religious dietary rules
Medical restrictions (diabetic, cardiac, renal, swallowing precautions)
Snacks they always liked (helpful during the sundown window)
Coffee, tea, alcohol preferences
Sweet tooth or not

Section 8 — What comforts them

Songs that always calm them
A specific blanket, sweater, or item they love
Prayers or verses that comfort them
The scent of a candle, lotion, or soap they associate with feeling safe
A photo album they love to look at
A pet or stuffed animal

Section 9 — What upsets them

Topics that agitate them (avoid unless they bring it up)
Situations they find frightening (loud noises, crowded rooms, being touched suddenly)
Words or phrases that provoke a bad reaction
People it upsets them to be reminded of
Times of day that are hardest

Section 10 — How to talk to them

What to call them (Mr. / Mrs., first name, nickname)
Preferred greeting
Their sense of humour (dry, warm, self-deprecating, none)
Are they a talker or a listener
Do they like being read to
Any known hearing impairment

Section 11 — Faith and end-of-life preferences

Faith community or church
Clergy contact
Advance directive on file (yes / no, where)
Do-not-resuscitate orders (yes / no)
Hospice preferences discussed (with whom)
Funeral wishes (broadly)

Section 12 — Anything else

What would you want a caregiver to know about your loved one that would make them treated as a whole person, not a patient? Write it here.

Where our Neuro-Aware Dementia Care program fits

Every family enrolled in our Neuro-Aware Dementia Care program completes this booklet with a Care Manager during intake. It goes into the care plan and is required reading for every caregiver on the case. It is the difference between a stranger walking in and a familiar face.

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