VALORACIÓN PSICOLOGICA

I. FICHA TECNICA #___________ Fecha:

_____________________________

Nombre: ____________________________________________________________

Edad: ______________________________________________________________

Grado Escolar: ______________________________________________________

II. MOTIVO DE CONSULTA:

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

III. ANAMNESIS:

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

IV.EXPLORACIÓN DE LA CONDUCTA:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

V. APLICACIÓN DE PRUEBAS:

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

VI. OBSERVACIONES

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

Profesional
Tarjeta Profesional