Caregiver Report
Caregiver Name*
Caregiver Phone*
Client's Firstname*
Client's Surname*
Dates and Times of Visits*
eg. 22-08-2008 eg. 2 - 4:30pm
Delete
Add extra visit date
Total Time Spent (Both boxes!)* hrs : mins
Total KMs Travelled* km
Activities of Care*
Companionship
Shopping
Cooking
Chatting
Walking
Personal Care
Driving
Housework
Reading
Childcare
Massage
Reiki
Counselling
Music therapy
Art therapy
Games, TV
Biography
Gardening
Meditation
Yoga
General Report about Client and/or Family*
Any Extraordinary Developments
Caregiver's Thoughts/Feelings*
Overall Relationship with Client* Good
Needs Improvement
Requested Response/FollowUp* Urgent
When able
Not necessary
(* Required fields)