361842913-Anamnese-Terapia-de-Casal

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ANAMNESE CASAL
IDENTIFICAÇÃO:
Nome: 
Data de Nascimento: Idade: 
Religião: 
Endereço: 
Profissão:
Telefone: E-mail: 
IDENTIFICAÇÃO:
Nome: 
Data de Nascimento: Idade: 
Religião: 
Endereço: 
Profissão:
Telefone: E-mail: 
MOTIVO DA CONSULTA E HISTORICO
QUEIXA PRINCIPAL:
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04- EVOLUÇÃO DA QUEIXA:
-Início da queixa:______________________________________________________________________
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- Súbita ou progressiva:_________________________________________________________________
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- Quais as mudanças que ocorreram/ o que afetou:____________________________________________
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- Sintomas:___________________________________________________________________________
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 QUEIXAS SECUNDÁRIAS:
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 HISTORIA DO CASAL- como se conheceram, como se apaixonaram, pontos negativos e pontos 
positivos
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HISTÓRIA FAMILIAR:
-Composição Familiar:________________________________________________________________
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-Dinâmica Familiar:____________________________________________________________________
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-Eventos Significativos:________________________________________________________________
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HISTÓRIA SOCIAL:
- Vida Social:_________________________________________________________________________
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- Hábitos de lazer: _____________________________________________________________________
- Inserção em Grupos:__________________________________________________________________ 
- Rede de Apoio:______________________________________________________________________ 
CONSIDERAÇÕES FINAIS:
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Gisele Ribeiro Gomes Rodrigues
Psicóloga CRP08/22651
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