# Emily Carter - Customization

Help us customize your experience with Emily to provide better support

Step 1 of 5 20% Complete

## Your Profile

Tell us about yourself and your caregiving role

What's your name? *
Please enter your name
How do you prefer to be addressed? *
Please enter your preferred form of address
What is your relationship to the person with dementia? *
Spouse
Child
Professional
Other
Please select your relationship
How familiar are you with dementia care? *
Beginner
New to caregiving
Intermediate
Some experience
Experienced
Extensive knowledge
Please select your experience level

## Patient Profile

Tell us about the person you're caring for

What is the name of the person you're caring for? *
Please enter the patient's name
What stage of dementia are they in? *
Early Stage
Middle Stage
Late Stage
Please select the dementia stage
What are their biggest daily challenges? * (Select all that apply)
Medication Adherence
Agitation
Wandering
Meals
Personal Hygiene
Please select at least one challenge
Do they have any impairments? * (Select all that apply)
Mobility
Vision
Hearing
None
Please select at least one option

## Routine & Care Needs

Help us understand the daily routine and care needs

What's a typical daily routine for them? *
Please describe the daily routine
Do they need help with medications? *
Yes
No
Please select an option
How many times a day? *
Please select a frequency
Are there specific behaviors you'd like help managing? *
Please describe the behaviors

## Caregiver Support

Tell us how we can support you as a caregiver

What's your biggest challenge as a caregiver? *
Please describe your biggest challenge
Would you like reminders to take breaks or practice self-care? *
Yes
No
Please select an option
What type of support would help most? * (Select all that apply)
Local Resources
Coping Tips
Emergency Contacts
Caregiver Community
Please select at least one support type

## Technical Setup

Help us configure the system to your preferences

Would you like notifications for reminders? *
Yes
No
Please select an option
What times would you like notifications? *
Morning (8am-12pm)
Afternoon (12pm-5pm)
Evening (5pm-9pm)
Night (9pm-11pm)
Please select at least one time period
Should the AI use: *
Simple Language
Detailed Explanations
Please select an option
Your Email Address *
Please enter a valid email address

## Submission Successful!

Thank you for providing your information. We'll use this to customize your experience and provide better support for you and your loved one.

To complete your registration, please continue to the payment page.

## Complete Your Registration

Secure payment to finalize your account setup

### Caregiver Support Subscription

Monthly subscription $39.99
Includes unlimited access to all features

Total $39.99/month
Card Information
Cardholder Name *
Please enter the cardholder name

Your payment is secured through Stripe

## Registration Complete!

Your account has been successfully created and your payment has been processed.

Welcome to our caregiving community!

You'll receive an email confirmation with your account details and next steps shortly.