Older Adult Care Plan Questionnaire

Tell us about your life, preferences, and the kind of support that would help you live confidently and independently.

You may skip any question you prefer not to answer. Only the final acknowledgment section is required.

Your Everyday Life

Help us understand your daily rhythm, routines, and what feels normal for you.

Morning routine

Daytime activities

Evening routine

Sleep preferences

The Things That Bring You Joy

Hobbies and interests

Favorite activities

Music, shows, or media you enjoy

Food, Comfort, and Mealtime Traditions

Favorite foods and drinks

Dietary needs or restrictions

Mealtime traditions or preferences

Culture, Faith, and Personal Traditions

Cultural background

Faith or spirituality

Traditions that matter to you

Family, Community, and Belonging

Important relationships

Community connections

Social preferences

The Right Kind of Connection

Qualities that matter in a caregiver

Preferred communication style

Pace and personality fit

One More Thing

What should a new caregiver know about you?

Communication Preferences

Preferred contact method

PhoneTextEmailIn-app messaging

Best time to reach you

Emergency contact name

Emergency contact phone

Emergency contact relationship

Acknowledgment & Consent

Please review and sign below. This section is required to submit your questionnaire.

I understand that Senioritis is a technology-enabled matching platform and not my employer or care provider.

I understand that caregivers are independent service providers, not Senioritis employees.

I understand that a match is not a guarantee of employment, availability, compatibility, or outcome.

I understand that Senioritis and caregivers do not replace medical professionals or emergency services.

Full legal name (e-signature) *

I agree to the Senioritis Terms and Privacy Policy and confirm this Older Adult Care Plan questionnaire submission.

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