Senior Citizen's Guide to Metro Detroit 35 Step 4. Take Action Questions: 1. _______________________________________________________ ________________________________________________________ 2. _______________________________________________________ ________________________________________________________ 3. _______________________________________________________ ________________________________________________________ 4. _______________________________________________________ ________________________________________________________ Bring to your next visit: q This Worksheet after you fill it out q The Caregiver Self- Assessment Worksheet q A list of your questions q Someone who can support you Care Team or Social Worker contact: Date:_ ___________________ Name:_ __________________ Phone:___________________ q Talk with my care team about my health needs q Talk with my mental health provider about my care needs q Talk with my social worker about getting long term care services q Get support from my family and friends q Write down my questions and bring them with me to my next visit q Other:_______________________________________________