Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Nome:
Nasc.:____/____/_____
Idade:
Signo:
Est. Civil:
Bairro:
Endereo:
Celular: (
Cidade:
Tel. Comercial: (
CEP:
)
Tel. Residencial: (
Email:
Profisso:
Qto. Tempo:
Empresa Atual:
Filhos:
Religio:
Motivo da Consulta:
J fez terapia antes:
Qual:
Quais:
fumante?
Quais:
Apar. digestivo:
Menst.Regular:
Menopausa:
Qto tempo:
Plula:
Clicas:
* Obs: (olhar cor do rosto, veias dos olhos, cor e umidade da lngua, pulso, olheiras, postura, se fica ansioso,
nervoso).
( )Tendinite
( ) Hipertenso
( ) Neurite
( ) Trombose
( ) Bursite
( ) Bursite
( ) Ndulos
( ) Traumatismo
( ) Tumor
( ) Fibromialgia
( ) Hepatite
( ) Cncer
( ) Feblite
( ) Anemia
( ) Alergia
( ) Escabiose
( ) Osteoporose
( ) Tireoidismo
( ) Artrose
( ) Problemas Cardacos
( )Prob. Neurolgicos
( ) Dilatao da Aorta
( ) Problemas Renais
( ) Outros - Quais:
Concluso:
3 - Periodicidade:
( ) Diria
( ) Semanal
( ) Quinzenal
( ) Mensal
OBS:
(CONFIRMO SEREM VERDADEIRAS E DE MINHA INTEIRA RESPONSABILIDADE AS INFORMAES POR MIM
PRESTADAS)
Local:..................................................................................
Data:___/_______/_______.
Ass:.......................................................................................
Avaliao Postural
( ) Cifose
( ) Lordose
( )Escoliose
( ) Joelho
( ) Valgo
( ) Valro
( ) P Cavo
( ) Plano
( ) Normal
Observaes: ____________________________________________________________________________
_______________________________________________________________________________________
TRATAMENTO
1 sesso: (____/_____/_____) Conduta: _____________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Evoluo: _______________________________________________________________________________
2 sesso: (____/_____/_____) Conduta: _____________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Evoluo: _______________________________________________________________________________
3 sesso: (____/_____/_____) Conduta: _____________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Evoluo: _______________________________________________________________________________
4 sesso: (____/_____/_____) Conduta: _____________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Evoluo: _______________________________________________________________________________
(____/_____/_____) Conduta: ______________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Evoluo: _______________________________________________________________________________
(____/_____/_____) Conduta: ______________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Evoluo: _______________________________________________________________________________