Escolar Documentos
Profissional Documentos
Cultura Documentos
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: _________________________________________________________________________________________
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O terapeuta pode optar por apenas um tipo detratamento, 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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