Anamnese Florais.docx

  • Uploaded by: raita
  • 0
  • 0
  • November 2019
  • PDF

This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA


Overview

Download & View Anamnese Florais.docx as PDF for free.

More details

  • Words: 452
  • Pages: 4
Ficha de anamnese para Terapia Floral

Nome:________________________________________________________________________ Data nascimento: ___/___/___ Endereço:_____________________________________________________________________ Bairro:_____________________Telefone:(____)______________________________________ email:________________________________________________________________________ Profissão:__________________ Estado civil:_________________________________________ Filhos:________________________________________________________________________ Padrão corporal: Atividade física regular? Não ( ) Sim ( ) Qual? _______________________________________ Cirurgias?_____________________________________________________________________ Fraturas?_____________________________________________________________________ Dores?_______________________________________________________________________ Saúde: Pele ( )__________________ Ginecológico / urológico ( ) ___________________Endócrino ( ) __________________ Renal ( ) ___________________ Digestivo ________________ Circulação / coração ( )__________________ Pressão: ____________Respiratório ( ) ____________________ Ósseo/coluna ( ) _____________________________ Funcionamento intestinal:_______________Alergias( )_____________________Diabetes( ) ______________ Faz uso de algum método contraceptivo? __________________________________________ Menopausa( ) Faz reposição hormonal?____________________________________________ Histórico oncológico:________________________________ Doenças Anteriores:______________________________ Tratamentos Anteriores:_________________________________________________________ Atualmente faz acompanhamento médico, psicológico ou outra terapia? _____________________________________________________________________________ Faz uso de alguma medicação? ______________________________________________________________________ Alimentação: Apetite:___________________Legumes/verduras ____________ Frutas ____________ Massas __________________ Carnes ___________ Leite_____________Frituras __________Açucar___________________ Faz dieta ___________ Café________________Álcool:____________________Qtde de água que ingere/dia ___________________________ VIDA (dia a dia)? Nível de stress ( ) baixo ( ) médio ( ) alto Possui algum vício? ______________________________________________ Nível de ansiedade ( ) baixo ( ) médio ( ) alto Dorme bem?______________________________________________________________ Familiar Quem mora com você?_____________________________________________________

Convivência? ( ) boa ( ) ruim ( ) conflituosa ( ) insatisfeito _____________________________________________________________________________ Profissional _____________________________________________________________________________ Relacionamento grupal no meio ambiente onde estuda ou trabalha? ( ) bom ( ) conflituoso ( ) péssimo Gosta do que faz/estuda? ( ) sim ( ) não ( ) faz por necessidade / Satisfeito com salário? ( ) sim ( ) não Leitura ( ) muito ( ) pouco ( ) detesta Última vez que tirou férias _________________________________________________________________________ Planejamento profissional/médio prazo:_______________________________________________________________ OBS.: ________________________________________________________________________ Social Possui amigos? ____________________________________________________________________________ Sai para se divertir? ( ) sim ( ) não ( ) muito pouco ( ) raramente Hobbies ( ) sim ( ) não__________________________________________________________________________ Religião ________________ ( ) freqüentador assíduo ( ) normal ( ) eventualmente Costuma viajar? ( ) sim ( ) não OBS.: _____________________________________________________________________________ 1º Consulta Data __ / __ / __ Motivo / queixas do cliente: _________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _____________________________________________________ Avaliação geral / observações /Sugestões/Fórmula:_________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________ 2º Consulta Data __ / __ / __ Motivo / queixas do cliente: _________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _____________________________________________________ Avaliação geral / observações /Sugestões/Fórmula: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _______________________________________________________ 3º Consulta Data __ / __ / __ Motivo / queixas do cliente: _________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _____________________________________________________ Avaliação geral / observações /Sugestões/Fórmula: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________ 4º Consulta Data __ / __ / __ Motivo / queixas do cliente: _________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________ Avaliação geral / observações /Sugestões/Fórmula: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

_________________________________________________________ 5º Consulta Data __ / __ / __ Motivo / queixas do cliente: _________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _____________________________________________________ Avaliação geral / observações /Sugestões/Fórmula: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _______________________________________________________

Related Documents

Anamnese
May 2020 5
Anamnese Florais.docx
November 2019 11
Anamnese-acupuntura.docx
October 2019 8
Ficha De Anamnese
November 2019 8
Modelo-anamnese-idoso.docx
November 2019 13

More Documents from "Edi A. Rossi"

140135.pdf
November 2019 3
Anamnese Florais.docx
November 2019 11
November 2019 11
November 2019 5
November 2019 7
November 2019 0