Options in Supported Living is now doing business as Compass.
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Please help us get to know you better by answering the following questions. If you need help, it is okay to ask someone to ask someone to help you! If something doesn’t apply to you, just leave it blank.
What time do you get up in the morning? 5am6am7am8am9am10amOther
What time do you usually shower/take a bath? MorningAfternoonEveningBefore bedOther
When do you eat breakfast? 5am6am7am8am9am10amOther
What time are your medications? MorningAfternoonEveningBefore bedOther
What time do you go to program/school/work? 5am6am7am8am9am10amOther
When do you eat lunch? 11am12pm1pm2pmOther
When do you usually run errands or go shopping? Daily in AMDaily in PMWeeklyMonthlyBi-MonthlyOther
What time do you return from program/school/work? 12pm1pm2pm3pm4pm5pmOther
When do you usually do laundry/dishes/housework? MorningAfternoonEveningBefore bedOther
When do you do your daily exercises? MorningAfternoonEveningBefore bedOther
What time do you eat dinner? 4pm5pm6pm7pm8pmOther
When do you start your usual nightly routine? 6pm7pm8pm9pm10pmOther
When do you usually go to bed? 6pm7pm8pm9pm10pm11pmOther
How often do you prefer to bathe/shower? More than once per dayDailyEvery other dayOther
What hygiene tasks do you need extra help with? BathingShavingToiletingTooth brushing/FlossingOther
What is your favorite food to eat and beverage to drink?
What is your most favorite meal or food item to make?
What is your least favorite meal or food item to make?
Do you need assistance from your staff with eating meals? All the timeSometimesNever
What was the school/program that you remember being the most fun for you and what made it so much fun?
Name a school/program experience that you didn’t like very much:
Who is/was your favorite staff and what made him/her so wonderful for you?
What quality do you most dislike in a staff?
Some things I would like my staff to know about me:
Do you like to keep your home neat/tidy or do you require a lot of assistance keeping organized?
What household chores do you like to do yourself?
What household chores do you want/need help with?
Are there places or things in your home that are off limits to others?
Do you prefer a lot of support during appointments? All the timeSometimesNever
Who do you like to have with you at medical appointments?
Have you needed staff guidance with filling pill boxes? All the timeSometimesNever
Do you go to the pharmacy to pick up medications or does someone do it for you? I go myselfSomeone helps meOther
How do you remember to take your medications each day?
Do you drink alcohol? YesNo
If so, how often
Do you smoke cigarettes? YesNo
If so, how many per day?
How often do you like to go shopping for groceries or other items? More than once a weekWeeklyTwo times a monthMonthlyAs Needed
What stores do you like to shop at?
Can you manage your own money, or do you need help?
Have you ever had problems with over-spending? If so, tell us about it.
Do you like to save money? YesNo
Do you ever run out of money? YesNo
What is your favorite activity to do on the weekends?
Who do you enjoy spending time with outside your home?
Who is your best friend?
What qualities do you seek in a friend?
Do you have any regular weekly activities that you participate in? (Things like: Church, Special Olympics, People First, etc.)
What is your favorite TV show?
What is your favorite movie?
What kind of movie do you like to watch? ComedyDramaAnimationHorrorOther
What type of books do you enjoy reading?
What kind of music do you like listening to?
What kind of physical activity do you like to do?
How often do you exercise? More than once per dayDailyEvery other dayOther
Do you have a favorite sport or physical activity?
Name a favorite childhood memory:
What made it such a fond memory for you?
Who are you closest to in your family and how often are you in touch?
Happiness: Think of something that makes you feel very happy.
What does being happy look like for you?
Sadness: What is something that makes you feel very sad?
What do you do when you feel sad?
What helps you when you feel sad?
Anger: Name something that makes you feel very angry:
What does being angry look like for you?
What helps you to calm down when you feel angry?
Fear: What is something that makes you feel very scared?
What helps you when you feel afraid?
Excitement: What is something that makes you feel excited?
What does being excited look like for you?
What is your favorite color?
If you could take a trip anywhere in the whole world, where would you go?
What do you feel has been your biggest accomplishment of the past year?
What are your goals for the next year?
What is something that you would like Compass to know about you?
What is the number one thing you would like Compass to help you with?
Use this box for anything you want. You could write a poem or story. It's up to you!
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