Clemens Health | How I prefer to communicate
Updated 2026-10-05 | (651) 354-1196

Download this editable worksheet, add your notes, and bring it to the relevant planning conversation. Leave unknown details blank and identify who can confirm them.

Addressing me
What name and way of addressing me do I prefer?
Your notes: ________________________________________

Understanding information
Which pace, format, environment or explanation helps me?
Your notes: ________________________________________

Expressing a choice
How do I want to ask questions, disagree, pause or say no?
Your notes: ________________________________________

Support from others
When do I want another person involved, and when should others speak directly to me?
Your notes: ________________________________________

Sharing and updating
Which details may be shared with whom, and how will I review this introduction?
Your notes: ________________________________________

Illustrative example
A person wants questions directed to them first and prefers time to think before a relative adds context. Their introduction states that preference clearly instead of saying only that the relative “handles communication.”

Next step
Review the introduction with the person and the provider before sharing it more widely. Ask how the provider will record and communicate the agreed preferences.

This is an optional discussion worksheet, not an official assessment, authorization, service plan, or emergency plan. Keep completed copies private and share through an agreed channel.