ANAMNESE HOLSTICA

MARA ANDRADE
NOME:________________________________________________________________
SEXO: Masculino ( ) Feminino (

IDADE: ____ anos

DATA DE NASCIMENTO: ____/____/____
PROFISSO: ______________________________________
ESTADO CIVIL: ___________________________________
DATA DE INICIO DO TRATAMENTO: ____/____/____

SADE

Nascimento:
____ MESES

SAUDAVEL: SIM ( ) NO ( )

DOENAS DURANTE GESTAO/NASCIMENTO: _________________________________________

DOENAS DO 0 AO 7 ANOS:
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DOENAS DO 7 AOS 14 ANOS:
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TENDNCIA DE HEMATOMAS E DOENAS: LADO ESQUERDO ( ) LADO DIREITO ( )
SADE DA ME:
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SADE DO PAI:
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POSSUI _______ IRMO(/OS)
RELAES:
ME: TIMA ( ) BOA ( ) RAZOAVEL ( ) ( ) nda
PAI: TIMA ( ) BOA ( ) RAZOAVEL ( ) ( ) nda

QUEM MORA NA CASA?

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PROBLEMAS DE SADE ATUAIS:

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TOMA ALGUMA MEDICAO? SIM ( ) NO ( )

QUAL?__________________________________

INFORMAES ADICIONAIS

COLESTEROL ALTO: SIM ( ) NO ( )

INSNIA: SIM ( ) NO ( )
TOC (TRANSTORNO OBSESSIVO COMPULSIVO): SIM ( ) NO ( )
QUAL?________________________________________________________________________________
ANSIEDADE: SIM ( ) NO ( )
DEPRESSO: SIM ( ) NO ( )
FOBIA: SIM ( ) NO ( ) QUAL? ________________________________________________________
INSATISFAO: SIM ( ) NO ( ) ONDE?_________________________________________________
APETITE DESREGULADO: SIM ( ) NO ( )
COME: MUITO ( ) POUCO ( ) NORMAL ( )
FAZ EXERCICIOS FISICOS? SIM ( ) NO ( )

FREQUNCIA: MUITO ( ) POUCO ( )

ALERGIA: SIM ( ) NO ( ) QUAL/ONDE?

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TPM: SIM ( ) NO ( ) SINTOMAS:
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RAIVA: SIM ( ) NO ( )
IRRITADIO: SIM ( ) NO ( )

O QUE GOSTARIA DE TRATAR:

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HARMONIA

Quanto voc se preocupa com sua sade?

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Voc possui alguma dor ou desconforto (fsicos)? Quais?
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Se respondeu sim ao desconforto fsico, complemente sua resposta relatando o quanto ela limita voc no seu
desempenho dirio.
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Voc tem alguma dificuldade para dormir (com o sono)?
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Voc experimenta sentimentos positivos em sua vida?
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Voc tem confiana em si mesmo?
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Algum sentimento tristeza ou de depresso lhe incomoda?Qual?
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Voc se sente sozinho em sua vida?
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Voc tem medo de alguma coisa.? Se no sabe, responda se tem medo ( mesmo que indefinido)
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Voc capaz de relaxar e curtir voc mesmo? O que busca para isso?
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Voc est satisfeito com a qualidade de sua vida? O que falta?
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O que mais lhe cansa no dia a dia?
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Tem o corao cheio de culpas?
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Guarda rancores?
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Tem mgoas que no consegue dissolver?
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Com que freqncia voc sente dor (fsica)?
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Qual o local mais freqente?
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O que faz para se aliviar nos momentos de grande tenso?
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Comente sobre a sua afetividade resumidamente:

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Sente melancolia sem razes aparentes?

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Responda a primeira coisa que lhe vier mente as seguintes questes:

O que que eu POSSO?

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O que que eu SEI?
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O que que eu AMO?
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Observaes do(a) cliente:

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FICHA TERAPUTICA
ANOTAES:
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RESUMO DAS CONSULTAS

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