Caregiver information form template
A care plan summary for carers, nurses and family.
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How to make a caregiver information form
- 1
Check the questions: rename, add or delete any field, or change how it’s answered.
- 2
Add your organisation’s name, a contact line and your logo if you like.
- 3
Choose fillable PDF, printable PDF, Word or HTML, and the paper size.
- 4
Download the caregiver information form and share it, print it or add it to your website.
About this caregiver information form
When someone else helps care for an elderly parent or a family member with a disability, a caregiver information sheet keeps care consistent: the person’s daily routine, medications and timing, mobility and help needed, diet, communication preferences, doctors, emergency contacts and what matters most to them.
Share it with home nurses, attendants, respite carers and relatives, and update it after hospital stays or medicine changes.
What’s on the caregiver information form
The template has 6 sections and 18 questions. Every one can be renamed, moved or deleted.
- Person cared for: Name; Date of birth; Address; Languages spoken; Likes to be called
- Health: Main conditions; Medications attached (yes or no); Allergies; Doctor and phone; Hospital preference
- Daily routine: Routine table (Time, Activity, Help needed)
- Support needs: Mobility (choose one: Independent, Walking stick, Walker, Wheelchair, Bed-bound); Help with (tick all that apply: Bathing, Dressing, Toileting, Eating, Medicines, Getting out of bed); Diet and fluids; Hearing, sight or memory needs
- What matters: Things they enjoy; Things that upset or calm them
- Contacts: Contacts table (Name, Relationship, Phone)
Tips
- Write the routine in the person’s own words where possible.
- Attach the current medication list.
- Note what upsets or calms them; it makes a big difference to new carers.
Four ways to save it
A fillable PDF has typing boxes, tick boxes and choices built in. A printable PDF gives clean boxes and writing lines for pen and paper. The Word file can be edited further, and the HTML code adds the same questions to a website. Browse more form templates, or design a completely different layout in the custom form builder.
Frequently asked questions
Is this a formal care plan?
It’s a practical summary for carers. Professional care providers may need their own assessment and plan.
Who should keep a copy?
Every regular carer, a family member and the person themselves, plus one by the phone at home.
Can I put the caregiver information form on my website?
Yes. Choose “HTML” to copy ready-made form code with labels and a simple style. Set the form’s action to the address that should receive submissions, such as your own form handler.
Can I add my logo to the caregiver information form?
Yes. Add your organisation’s name, a contact line and a logo in “Form details”. The logo is placed into the file on your device and is never uploaded.
Can people fill in this caregiver information form on a phone?
Yes. Choose “Fillable PDF” and send the file. It opens in the Files or Drive app on Android, Files on iPhone, and any browser on a computer, where people can type their answers and save the result.
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