Life Story Template

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My Life Story Book
This life story book has been created to provide you, the
health care-giver, with information about…
____<<Insert Name Here>>____
Purpose of the Life Story Book
While I may sometimes have difficulty remembering
things or communicating clearly, I am a unique
person with my own memories, experiences, and
preferences. I have helped to create this book
because it is my hope that this information will
help you to provide compassionate and personalized
care for me.
Thank you for taking the time to read this, and for
providing care.
Purpose of the Life Story Book
Information in this book is:
• condensed and simplified;
• provides a quick “snap-shot” of this person’s story and
special care needs;
• Contains the most important personal information for care:
My Life Reflections
 My Family and Home Life
 Helping Me in Everyday Life
 I Look Forward to…/ Hopes and Dreams

This book can help you to…
Examples:
• …tailor direct care to better meet my personal
preferences
• …guide and add meaning to conversations with me
• …support my sense of self-worth & self-esteem;
• engage me in activities that are meaningful and
continue my life experiences
My Life Reflection
 I am…/ I was…/ I did… (List Major
Life Achievements and
Accomplishments)
“This is a
long ago photo of me’
“Back then I…”
My Life Reflection
 I always… (Identify Life-long Habits
that would help provide care)
“This is a
long ago photo of me’
“Back then I…”
My Life Reflection
 I remember…When I… (Identify
significant positive memories,
familiar family stories, etc.)
“This is a
long ago photo of me’
“Back then I…”
My Life Reflection
 When I was… (identify significant
life &/or historical landmarks, e.g.,
marriage, children, war years,
immigrating)
“This is a
long ago photo of me’
“Back then I…”
My Family and Home Life
 Family, friends and pets who are
important to me are: (List names &
relationships)
a) Current
b) Past
This is
Here I am
with….
We went to…
My Family and Home Life
 My favourite memory(ies) of time
with… (family, friends, pets) is/are…
This is
Here I am
with….
We went to…
My Family and Home Life
 My special memories of home are
(specify)…
This is
Here I am
with….
We went to…
Helping me in everyday life
 My personal preferences when
helping me with my care
include:
Examples:, Sleeping position;
Food/Beverage favourites
This is a
picture of
me when I
was…
…Independent…
…enjoying…
…doing…
Helping me in everyday life
 I like talking about…
This is a
picture of
me when I
was…
…Independent…
…enjoying…
…doing…
Helping me in everyday life
 I like it when others ask me…
This is a
picture of
me when I
was…
…Independent…
…enjoying…
…doing…
Helping me in everyday life
 I am most comfortable when…
This is a
picture of
me when I
was…
…Independent…
…enjoying…
…doing…
Helping me in everyday life
 What gives me pleasure is…
(especially sensory information)
This is a
picture of
me when I
was…
…Independent…
…enjoying…
…doing…
I am looking forward to…
 My favourite traditions,
holidays, seasons are
Here is a
picture of me
celebrating…
I am looking forward to…
 I always celebrate…(describe)
Here is a
picture of me
celebrating…
My Hopes and Dreams
(List Known Aspirations
and Hopes)
 I want to see…
 I hope to…
Here is a
picture of me
celebrating…
Hopes and Dreams
List Known Aspirations and
Hopes (continued):
 I always wished…
 I would like to participate in…
Here is a
picture of me
celebrating…
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