Page 20 - From Good Sleep to Wellness
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RESIDENT PREFERENCES
Resident Name: ___________________________ Household/Bedroom #: ________________
Preferred Name:
Usual time to arise:
Daytime Clothing:
Morning Routines/Activities:
Bathing Preferences
⬜ Shower
⬜ Spa
⬜ Towel Bath
⬜ Other: __________
⬜ Before Breakfast
⬜ After Breakfast
⬜ Before Bedtime
⬜ Other: ______________
How Often or What Days?
Special Request
Grooming
Oral Hygiene ⬜ Independent
⬜ Setup
⬜ Assist
⬜ Denture Care
Hair Care ⬜ Independent
⬜ Setup
⬜ Assist
⬜ Other: ______________
Preferences and needs:
Other Preferences
Form #: Date Revised: Date Implemented: © 2005 Manhattan Retirement Foundation Inc.
