Whimble - Client Onboarding Form

Please contact hello@whimble.ca or 1-855-542-6082 if this form is inaccessible to you, or if you'd prefer to fill it out with assistance.

The Basics

First name*

Last name*

Email*

Phone number*

Full address*

Do you have any accessibility requirements we should be aware of in our communications with you?

Your pronouns:*

They/them

She/her

He/him

Other

Now Let's Get to Know You Better!

Do you have any allergies caregivers need to be aware of?*

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?*

I live alone

I live with family

I live with friends

Other

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.)

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.

Bathing, Dressing & Personal Care Routine

e.g.:
"I have a shower chair I pivot transfer onto"
"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"
"my leg bag is strapped to my left leg and needs to be emptied every 4 hours"

Meal Prep

e.g.:
"I follow a special diet and will provide exact recipes and ingredients"

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 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"
"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"
"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"

Last but not least! - Emergency Contact Information

Emergency Contact's First Name:*

Emergency Contact's Last Name:*

Emergency Contact's Phone #:*

Your Relationship with Emergency Contact:*

The Fine Print

By submitting this information, You (the Client) confirm that:*

I am able to self-direct my care by providing direction to a caregiver with reasonable experience, OR:

I am unable to self-direct my care, however a parent or guardian will supervise my care at all times.

I acknowledge that Whimble Care Inc. does not provide emergency services for medical emergencies or other issues that could be life threatening or otherwise result in serious harm/injury.

I am 18 years of age or older, OR I am under the age of 18 but my parent/guardian consents to my use of on demand caregivers and attests I can self-direct my care with or without their presence.

I acknowledge that, while every effort will be made to fulfill service requests, Whimble Care Inc. does not guarantee service. You will not be charged for any unfulfilled requests.

I have read and accept Whimble Care Inc.'s Terms of Service, Client Code of Conduct, and Privacy Policy, available at: https://www.whimble.ca/terms-and-conditions.

That's it for now! We'll be in touch ASAP to book your home visit.

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 :)