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1. UNIVERSIDAD DE MONTEMORELOS
Facultad de Psicología
Teorías y técnicas de la entrevista
FICHA DE IDENTIFICACIÓN
NOMBRE: _______________________________________________________________________
Fecha de nacimiento: __________________ Edad: ______________
Ocupación: ________________
Religión: ____________________________
FECHA DE REGISTR0 TRO DE CITA: ____ /____ /____
MOTIVO DE CONSULTA Y DESCRIPCIÓN DEL PROBLEMA ACTUAL:
OBSERVACIONES:

2. GENOGRAMA:
ANTECEDENTES PERSONALES Y FAMILIARES:
RECOMENDACIONES:

3. REFERIDO A: ____________________________
OBSERVACIONES:
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4. TERAPEUTA:_________________________________