ENTREVISTA COM ADOLESCENTE

Dados de Identificação

Nome: ________________________________________________________________
Data de nascimento: ____/____/_____ Idade: __________________________
Sexo: ______________
Escolaridade: __________________________
Atividades:_________________________________________________________________
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Saúde: _____________________________________________________________________
Já fez acompanhamento psicológico? _____ Queixa: ______________________________
Motivo do encaminhamento ao para avaliação: ___________________________________
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O que sabe dos motivos da entrevista.

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História de vida pregressa. Dificuldades e desafios.

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Relação com os pais na infância/ adotivos.

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Adolescência.
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Relação com a família materna e paterna.

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Escolarização (áreas de interesse, dificuldades de aprendizagem, reprovação, evasão,

problemas de relacionamento com outros colegas).
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Relação de amizade.
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Uso de substância psicoativa.

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O que gosta de fazer nas horas de folga.

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Relacionamentos amorosos.
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Sexualidade (questões que levaram ao acolhimento como estão elaboradas).

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Carreira Profissional.
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Sonhos para seu futuro.
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Relacionamento com ..................................................................................................................

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Proposta de filiação adotiva.

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O que pensa sobre mudança de sobrenome. Mudança de paternidade/ compreende que é

medida irreversível.
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Observações:

Apresentação pessoal: ________________________________________________________

Conduta frente a entrevista: __________________________________________________
Consciência: ________________________________________________________________
Linguagem: ________________________________________________________________
Estado de Humor: ___________________________________________________________
Memória: __________________________________________________________________

Conclusões:

Demanda explícita: _________________________________________________________

Demanda implícita: _________________________________________________________
Necessidade de acompanhamento psicológico ___________________________________
Qual a terapêutica mais indicada: _____________________________________________

Data: ____/____/_____