FICHA DO ALUNO

Nome:_________________________________________________________________________
Data de nascimento: ____/____/____ Idade: _______
Nome da mãe:__________________________________________________________________
Nome do pai:___________________________________________________________________
Endereço:______________________________________________________________________
Telefone:_______________________________________________________________________
Escola:________________________________________________________________________
Série/Ano:_____________________________________________________________________
Houve reprova?_________________________________________________________________
Interações com os colegas e professores:_____________________________________________

Dificuldades escolares:___________________________________________________________

Atendimentos:
Reforço escolar:_________________________________________________
Fonoaudiólogo:__________________________________________________
Psicólogo:______________________________________________________
Neuropediatra:__________________________________________________
Outros:________________________________________________________
Medicamentos:__________________________________________________
Exames realizados:___________________________________________________

Queixa/Informações
complementares:________________________________________________________________
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