Your Name
Your Relationship to Your Loved One
Mother
Father
Spouse/Partner
Sibling
Child
Grandparent
Friend
Other
Loved One’s Full Name
What would you like your loved one to know?
What are you most proud of about them?
What do you miss most about them?
What hope do you have for their future?
Is there anything you want them to remember during treatment?
A favorite memory you want to share
Something you want to apologize for or say with honesty
Something you want to encourage them about
A message of love or support