The Hospice Life Review Form

Volunteer's name: __________________________________________________________

What is it that you are hoping to accomplish with your life review?

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With regard to the questions on the Hospice Life Review Form, would it be more helpful if I:

1. Forgot about the questions and just listened attentively?
2. Interjected a question here and there?
3. Used the questions to help guide your recollections?

Is there anything that you would rather not talk about?

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At what point in your life story would you like to start? (The questions are arranged chronologically)

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Childhood

• What do you remember about when you were a young child? What was life like?
• Who took care of you? What were they like?
• Did you have any brothers or sisters? If yes, what were each of them like?
• Where did you live?

Adolescence

• What do you remember about being a teenager?
• Where did you go to school? What was your school like?
• Who were your closest friends?
• Was there someone that you especially admired?
• What was your relationship like with your parents?
• Were there grandparents, aunts, uncles, cousins, etc who you were close to?
• Who was your "first love"?
• What was the most unpleasant thing about being a teenager?
• What was the best thing about being a teenager?

Adulthood

• What was life like for you in your twenties and thirties?
• What kind of person were you?
• What did you enjoy doing?
• Did you go to college?
• Was there someone you shared your life with? How did you meet?
• What kind of work did you do?
• What were some of the challenges you faced in your adult years?
• Who were your closest friends?
• What were some of the "defining moments" in your life?
• Where did you live in your adult years?
• Did you have children? What can you remember about each one?
• Is there a faith tradition that you are a part of? If yes, is this an important part of your life?
• What are some of the significant historical events that you remember?

General

• What are your greatest achievements?
• If you were going to live your life over again, what would you do differently? The same?
• What was the unhappiest period of your life? What did you learn from it?
• What was the happiest period of your life?
• What were the most difficult things that you have had to deal with in your life?
• Tell me about your experience living with a terminal illness or coming to terms with your own mortality.
• Do you have any other words of wisdom that you would like to pass on?

Adapted from Barbara Haight's Life Review and Experiencing Form
© 2000 The Hospice of the Florida Suncoast
Published here with permission.