Anamnese musicoterápica

1. Anamnese Musicoterápica
Nome:_____________________________________________________________________
________
Nome Social:
______________________________________________________________________
Idade:_____________ Sexo:_______________ Orientação Sexual:
_________________________
CPF:_________________________________
Identidade:__________________________________
Endereço:__________________________________________________________________
_______
Bairro:_________________________________
Cidade:____________________________________
Religião:______________________________
Escolaridade:________________________________
Cel
contato:____________________________________________________________________
____ Rede Social
:_______________________________________________________________________
__________________________________________________________________________
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Profissão:__________________________________________________________________
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Est.Civil:___________________________________________________________________
________
Cônjuge (nome, idade, profissão,
escolaridade):________________________________________
__________________________________________________________________________
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Filhos (nome, idade e
sexo)__________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
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Tutor ou responsável: (nome, idade, profissão,
escolaridade):____________________________
__________________________________________________________________________
_________
__________________________________________________________________________
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Possibilidade de
horários:___________________________________________________________
__________________________________________________________________________
_________ Diagnóstico Médico:
________________________________________________________________
__________________________________________________________________________
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Diagnóstico Psicológico:
____________________________________________________________
__________________________________________________________________________
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Diagnóstico Diferencial:
_____________________________________________________________

2. __________________________________________________________________________
_________ Fez ou faz alguma terapia? (citar qual e
quando)________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Expectativas e objetivos do
paciente:_________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ Sintomas
apresentados:_____________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
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__________________________________________________________________________
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Patologias existentes ou pré-
existentes:_______________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
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Transtornos:
_______________________________________________________________________
__________________________________________________________________________
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Transtornos
familiares:______________________________________________________________
__________________________________________________________________________
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Patologias importantes familiares:
____________________________________________________
__________________________________________________________________________
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__________________________________________________________________________
_________ Eventos traumáticos de
vida:_________________________________________________________
__________________________________________________________________________
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__________________________________________________________________________
_________ Relacionamentos Importantes
Conjuje:____________________________________________________________________
_______
__________________________________________________________________________
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Mãe:______________________________________________________________________
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__________________________________________________________________________
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3. Pai:_______________________________________________________________________
________
__________________________________________________________________________
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Irmãos:____________________________________________________________________
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__________________________________________________________________________
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Filhos:_____________________________________________________________________
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__________________________________________________________________________
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Outros
importantes:________________________________________________________________
_
__________________________________________________________________________
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Observações sobre dinâmica familiar
atual:____________________________________________
__________________________________________________________________________
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__________________________________________________________________________
_________
__________________________________________________________________________
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__________________________________________________________________________
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Infância Gravidez (planejada ou não), parto, intercorrências
obstétricas:___________________
__________________________________________________________________________
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__________________________________________________________________________
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Desenvolvimento infanto-
juvenil:_____________________________________________________
__________________________________________________________________________
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__________________________________________________________________________
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__________________________________________________________________________
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Desenvolvimento
adolescência:______________________________________________________
__________________________________________________________________________
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Vida adulta:
_______________________________________________________________________
__________________________________________________________________________
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__________________________________________________________________________
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4. Terceira idade:
_____________________________________________________________________
__________________________________________________________________________
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__________________________________________________________________________
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Comorbidades:
____________________________________________________________________
__________________________________________________________________________
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__________________________________________________________________________
_________ Outros transtornos infantis (sono, alimentação, psicomotor, gagueira, tiques,
sonambulismo,
aprendizagem):______________________________________________________________
_______
__________________________________________________________________________
_________
__________________________________________________________________________
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Outros
comentários:________________________________________________________________
__________________________________________________________________________
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__________________________________________________________________________
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Experiências afetivas
marcantes:_____________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
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Gosto esportivo
conflitante:__________________________________________________________
__________________________________________________________________________
_________
Círculo de
amizades:________________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ Situação
Financeira:________________________________________________________________
__________________________________________________________________________
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Observação e Linguagem Não verbal do Paciente
Observações:_______________________________________________________________
_______
__________________________________________________________________________
_________
__________________________________________________________________________
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__________________________________________________________________________
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Grupo social e situação geográfica que vive:
__________________________________________

5. __________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ experiência musical
gestacional:_____________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
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Situação musical social/grupal:
______________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
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Experiência Musical
religiosa:________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
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Experiência instrumental:
___________________________________________________________
__________________________________________________________________________
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__________________________________________________________________________
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Gosto de( musica / estilo / musico ou grupo
Musical)___________________________________
__________________________________________________________________________
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__________________________________________________________________________
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__________________________________________________________________________
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__________________________________________________________________________
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Experiência
instrumental:____________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ Rejeição a estilo / musica / som / instrumento:
_________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
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Experiencial sonoro musical de vínculos afetivos:
______________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
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6. Gosto audiovisual (cinematográfico/ desenho animado/ clipes) relevantes: ________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ experiência tecnológicas:
___________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ observações importantes:
___________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
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__________________________________________________________________________
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__________________________________________________________________________
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7. __________________________________________________________________________
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