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FICHA CLNICA TERAPIA FLORAL Fecha ______________

SESION N_____ NOMBRE ALUMNO-A ____________________________________________

Nombre consultante _________________________________________________________RUT________________ Edad _________

Direccin______________________________________________________________________________Comuna_______________

Telfono fijo ________________________ Celular_____________________ Telfono de recado ___________________________

Mail ________________________________________________________________________________________________________

Ocupacin __________________________________________________________________________________________________

Est o ha estado en algn tratamiento mdico psicolgico psiquitrico e. florales ninguno

Mes(es) y ao(s) tratamiento ____________________________________________________________________________________

Diagnostico
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MOTIVO DE CONSULTA FLORAL _______________________________________________________

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VERBALIZACIONES FLOR
__________________________________________________________________ ____________
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FLORES QUE RECET PARA QUE RECET CADA FLOR
FRASCO 1

1 ___________________ _______________________________________________________________________________
2 ___________________ _______________________________________________________________________________
3 ___________________ _______________________________________________________________________________
4 ___________________ _______________________________________________________________________________
5 ___________________ _______________________________________________________________________________
6 ___________________ _______________________________________________________________________________
7 ___________________ _______________________________________________________________________________

DOSIFICACION Y FRECUENCIA ____ gotas ____ veces al da