Documentos de Académico
Documentos de Profesional
Documentos de Cultura
DATOS PERSONALES
Nombre: __________________________________________ Sexo _____________________________
ESTRUCTURA FAMILIAR:
Padre: __________________________________ Edad: _________ escolaridad___________________
Hermanos_______________________________
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Relaciones emocionales e interpersonales con otros miembros de la familia_______________________
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DESARROLLO EVOLUTIVO
Hijo deseado: ________________ No Deseado __________________ Accidental: _______________________
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Alimentacin:
Lactancia: Normal: ______ Artificial: ______ Mixta: ______________ Ritmo: __________________________
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Lenguaje
Balbuceo: __________________________ Imitacin De Sonidos: ____________________________________
Sueo
Lugar: ______________________________________________ Slo: _____ Acompaado: _____ Edad: _____
NECESIDAD DE ELEMENTOS DE COMPAA: Luz: ____ Juguetes: ____ Almohada: _____ Horario: ________
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Enfermedades y trastornos psicolgicos
Antecedentes Familiares: _____________________________________________________________________
Alergia: ________ Nauseas: ________ Vmito: ________ Anorexia: _________ Bulimia: __________________
Bruxismo: _________ Enuresis: _________ Encopresis: _________ Onicofagia: _______ Tics Nervioso: ______
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rea sexual
Masturbacin: _______ Curiosidad Sexual De La Infancia: _______ Edad: ______ Reacciones: ______________
Juegos
Preferidos: ______________________________ Slo: _______ Compaa: _____ Activos: _____ Pasivos: ______
ESCOLARIDAD
Edad: ________ Reacciones De Inicio: ___________________________________________________________
Hbitos de estudios_____________________________________________________________________________
NIVEL DE AUTO EXIGENCIA: Baja: ____ Intermedia: _____ Alta: _____ Responsabilidad: Si: ____ No: ____
Actitud/Padres Y Familiares Ante Rendimiento: Optimista: ______ Conformista: _________ Pesimista: __________
SOCIABILIDAD
AMIGOS PREFERIDOS: S: __ No: __
RELACIN CON COMPAEROS: Excelente: ___ Muy Buena: ____ Buena: _____ Regular: _____ Mala: ____
RELACIN CON LOS MAESTROS: Excelente: ____ Muy Buena: ___ Buena: ___ Regular: ____ Mala: ____
REACCIN ANTE MUDANZA: Ira: ___ Inconformidad: ___ Alegra: ____ Impotencia: ____
TIEMPO DEDICADO POR PADRES A LA CONVIVENCIA FAMILIAR: POCO: ___ Nada: ___ Mucho:____
APLICACIN DE DISCIPLINA:
PREMIOS: Por Obediencia: ___ Responsabilidad: __ Cumpleaos: __ Excelentes Calificaciones: ____
DISCIPLINA POR: Desobediente: ___ Irresponsable: _____ Irrespetuoso: _____ Malas Calificaciones: ______
HIJOS PREFERIDOS: Mayor: ___ Menor: ___ Varn: ____ Mujer: ____
RELACION ENTRE LOS PADRES: Excelentes: ___ Muy Buenas: ___ Buenas: ___ Malas: ____ Regular: ____
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RELIGION: Frontal: ___ Prudente: ____ Activa: ___ Pasiva: ___ Cerrada: ____
ORDEN SOCIAL: Pasiva: ___ Compromisos: Muchos: ___ Pocos: ___ Nada: ____
SITUACION ECONOMICA: Baja: ____ Media: ____ Media Alta: _____ Alta: _____
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Masturbacin_________________________________________________________________________________
ADULTEZ
Enamoramiento__________________________________ matrimonio_______________________________
Masturbacin_________________________________________________________________________________
Otros_______________________________________________________________________________________
ADULTO MAYOR
Jubilado______ otros__________________________________________________________________________
Otros_______________________________________________________________________________________
ANALISIS TOPOGRAFICO
RESUMEN PSICODIAGNOSTICO DE LOS TEST:
INTELIGENCIA________________________________________________________________________________
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PERSONALIDAD______________________________________________________________________________
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OTROS______________________________________________________________________________________
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PSICODIAGNSTICO__________________________________________________________________________
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PRONOSTICO________________________________________________________________________________
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PSICOTERAPIA_______________________________________________________________________________
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RECOMENDACIONES:
Familiares____________________________________________________________________________________
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Escolares_____________________________________________________________________________________
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Laborales_____________________________________________________________________________________
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Medicas______________________________________________________________________________________
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Otros________________________________________________________________________________________
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