Something Worth Remembering Pre-Interview Questionnaire

This questionnaire helps me shape a conversation that feels personal, natural, and comfortable. Brief answers are perfectly fine. You may leave anything blank or indicate that you would prefer to discuss it privately.

First name

Last name

Phone

What is the occasion or reason for this recording?

Who is the recording being created for?

What would you most like them to receive from it?

Are there particular people, relationships, places, or periods of your life you would enjoy talking about?

Is there a story or part of your life you have always wanted your family to know more about?

What do you hope the people who love you understand about you?

Are there values, lessons, memories, or messages you especially want to preserve?

Are there any family expressions, traditions, ordinary rituals, or small details that feel important to include?

Are there questions you would particularly like me to ask?

Are there subjects you would prefer not to discuss or would like me to approach carefully?

Have there been any recent losses, family changes, health concerns, or difficult experiences that I should be aware of when preparing?

Have you been interviewed or filmed before? If so, what helped you feel comfortable?

Are there any hearing, memory, mobility, fatigue, or communication considerations that would help me make the session easier for you?

Is there anything else you would like me to understand before we speak?

Any special considerations (sensory, mobility, cognitive, emotional)

Disclaimer / Important Note: I am not a medical doctor, psychologist, or licensed mental health professional. My coaching and support are based on my personal experiences navigating caregiving, trauma, and family dynamics in my own life.

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