I.E.P MENDEL

IEP Nuestra Seora de las GraciasDepartamento de Psicologa Svieta Valia Fernandez Gonzlez, PsiclogaFICHA DE ATENCIN A PADRES DE FAMILIA

Fecha de entrevista _________________________

1. DATOS PERSONALES Apellidos y Nombres: _____________________________________________________ Edad: ____________________Telfonos: _____________________________ Nivel Educativo: ____________________ Ocupacin: __________________________ Centro de trabajo:_________________________ Horario de trabajo: ______________ Parentesco ____________________________________________________________ Nombre del Alumno ____________________________________________________ Nivel, Ao y seccin _________________________________ Consulta ( )Citacin ( ) Otro( ) ___________________

2. MOTIVO DE ATENCIN ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

3. FAMILIOGRAMA

4. DESCRIPCIN DEL PROBLEMA____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

5. CONCLUSIONES____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

6. SUGERENCIAS____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

7. ACCIONES A TOMAR (I.E)

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_______________________________DEPARTAMENTO DE PSICOLOGA