Wanderers Information Sheet

Purpose: Please use this form to provide information in case the person wanders away or becomes lost. Keep a copy of this sheet handy to give to law enforcement. All searches begin with an investigative component.  During this time you will be asked dozens of questions to aid law enforcement and search teams determine where and how to look.  This information is critical to the success of the search.  Completion of this form, before an incident, allows the searching to start sooner and aids in collecting more accurate information.

Wanderer Information

First Name:	Middle Name:			Last Name:
First or Nickname:	Name to call:			Social Security #
Home Street Address:		City:			State:	Zip Code:
Local Street Address: (if applicable)		City:			State:	Zip code:
Home Phone #:			Local Phone #: (if applicable)

Contact Information (person providing information)

First Name:		Middle Name:			Last Name:
Relationship to Wanderer:					Date Completed:
Home Street Address:			City:			State:	Zip Code:
Local Street Address: (if applicable)			City:			State:	Zip code:
Home Phone #:				Local Phone #: (if applicable)
Cell Phone #: (if applicable)	Pager #:			Work Phone #: (if applicable)

Physical Description

Date of Birth:	Age:		Sex:		Race:
Height:	Weight:		Build:		Hair Color:
Hair Length:	Hair Style:		Balding?		Mustache?
Beard?	Sideburns?		Facial Features/shape:		Complexion:
Marks/Scars/Tattoos:		General Appearance:		Eye Color:

Accessories and Equipment

Item	Owns?	Description	Missing?*
Glasses	Yes ‘ No ‘		Yes ‘
Dentures	Yes ‘ No ‘		Yes ‘
Hearing Aid	Yes ‘ No ‘		Yes ‘
Cane or walker	Yes ‘ No ‘		Yes ‘
Watch	Yes ‘ No ‘		Yes ‘
Jewelry	Yes ‘ No ‘		Yes ‘
Wallet/purse Contents	Yes ‘ No ‘		Yes ‘
Keys	Yes ‘ No ‘		Yes ‘
Safe Return Products	Yes ‘ No ‘		Yes ‘
Other items (tissue, tobacco, matches, lighter, items stuffed in pockets, etc)	Yes ‘ No ‘		Yes ‘

* Complete the shaded missing column only if a wandering incident occurs. If it appears the wanderer has the item with them check yes.

Clothing Worn When Last Seen

Fill in this section only if a wandering incident occurs. On a separate sheet of paper you might consider keeping an inventory of the person’s clothing and footwear.

Item	Style/Description	Color
Hat/Cap
Shirt
Pants
Dress
Sweater
Coat/Jacket
Raingear
Footwear
Hose/Socks
Underwear
Other

Physical Health

Known Physical disabilities:
Uncorrected Vision:	Uncorrected hearing:
Known Medical conditions:
General Physical condition:
Prescribed Medications:
Over-the-Counter Medications:
Consequences of not taking medication:
General Physician: Address:	Office Phone Number:
Emergency Phone Number:

Dementia/Alzheimer’s Questions

Dementia Diagnosis: (Alzheimer’s, Vascular, Parkinson’s, etc)
Neurologist/Gerontologist: Address:	Office Phone Number: Emergency Number: