Beruflich Dokumente
Kultur Dokumente
Nome: _____________________________________________________Nasc.____________________
Estado Civil:__________________Cônjuge:________________________________________________
Filhos (nome e idade) ____________________________________________________________________
Endereço:____________________________________________________________________________
Tel./celular______________________________________e-mail:_______________________________
Profssão:____________________________________________________________________________
Em caso de emergência avisar:_____________________________________Fone:__________________
Queixa principal: _____________________________________________________________________
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Aspecto mental/emocional (Ansiedade, nervosismo, irritação, raiva, depressão, angústia, medos, pânico, insônia, cansaço, etc. )
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Outros: _________________________________________________________________________________________
Observações: (Relacionamento familiar, vida social, hábitos de lazer, alimentação, eventos significativos)
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O terapeuta pode optar por apenas um tipo de tratamento, ou vários, se julgar necessário.
A escolha será sempre o que melhor auxiliar as necessidades do paciente.
Consultas
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Data Sintomas / diagnóstico Tratamento - em detalhes
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