Whimble - Client Onboarding Form
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The Basics
Your name: *
Your email:  *
Phone #:  *
Address: *
Do you have any accessibility requirements we should be aware of in our communications with you?
Your age: *
Your pronouns: *
Required
Now Let's Get to Know You Better!
Do you have any allergies caregivers need to be aware of? *
Gender preference for caregivers? *
Required
If you have pets, please tell us about them!
Do you hold any religious beliefs caregivers should be aware of (such as those requiring specific meal preparation procedures)?
What is your current living situation? *
Your approximate weight (please specify lb or kg) *
How would you describe your disability to an attendant you haven't worked with before? (Please note this response is entirely optional.)
Your Routine!
We currently offer 6 types of services, please check off all that might apply given your needs. (Check out www.whimble.ca/services for more information on each offering.)
 *
Required
Where might our services be of use? (please check all that apply) *
Required
Almost done... let's make sure we have all the necessary information on hand for attendants to quickly review before any service requests.

Please fill out the sections below that you think will apply (e.g. if you don't anticipate EVER needing help with meal prep, skip that section!) And feel free to go into as much or as little detail as you are comfortable with - ultimately you will be self-directing your care and in total control at each visit, but we're happy to pass along any details that can help make the process more smooth.

It's important to note we'll only share the necessary info with future matched attendants (e.g. if you need something picked up at the post office we won't be like "this person uses this type of catheter"!)
Bathing, Dressing & Personal Care Routine
e.g.: 
"I have a shower chair that the attendant helps me transfer into"
"if cold water touches my body I will scream"
"I like to iron my socks before putting them on"
"I use a Hoyer lift to transfer into my shower chair but sometimes it gets stuck and you have to sweet talk it a bit"
Bathroom Routine
e.g.: 
"for bowel care, I use a cecostomy tube to flush my system using glycerine, I'll provide the exact formula"
"I can self-cath but need someone to help me position my catheter"
"my urinary leg bag is strapped to my left leg and needs to be emptied every 4 hours"
"when I'm at work, I use the accessible washroom on the 4th floor"
Meal Prep
e.g.: 
"I follow a special diet and will provide exact recipes and ingredients"
"I like my food EXTRA spicy"
"I cannot stand when foods touch on my plate"
Housekeeping
e.g.:
"I am extremely sensitive to scents and will provide all my own cleaning supplies"
"I have a cat and need the litterbox emptied every day"
"please make sure to switch the laundry over before you leave"
"sometimes I forget to check if the garbage is full, so please always check it (beside the sink) before you leave"
Errands
e.g.:
"My preferred grocery store is the Loblaws on Bank"
"my building has a mailroom where delivery drivers leave packages, but you'll have to come up and get the mailroom key before being able to access it and retrieve my package"
"I only eat organic fruits and vegetables and may sometimes forget to note this on my shopping list"
"my cat's vet is the Centretown Veterinary Hospital at 955 Somerset St W - they have her on file under my name"
Roadside Assistance
e.g.:
"once in a while the electrical controls fail on my wheelchair and I need a push home"
"be careful as my neck can easily fall off my headrest"
"when I'm too far from home for anyone to push me I'd just like a buddy to hang out with while I wait for a taxi to show up"
Other
Anything else attendants should be aware of? e.g.:
"I know the seatbelt is cut off of my shower chair, I find it just gets in the way and I accept this risk"
"if I hear anyone whistling at any time I want to scream"
"I am not a morning person. It's not you, it's me."
"I use a picture board to communicate my needs"
Last but not least! - Emergency Contact Information
Emergency Contact's Name: *
Emergency Contact's Phone #:
 *
Your Relationship with Emergency Contact:
 *
The Fine Print
By submitting this information, You (the Client) confirm that: *
Required
That's it for now! We'll be in touch ASAP to chat through next steps. 

Please note - if we DIDN'T ask something you think we should be noting, or have any other feedback about this process, please let us know below :)
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