Universidad

Continental

ANAMNESIS
PSICOLOGICA
(Tomado de Carlos A. Seguín)
Adaptado por Ps. David F. Noreña Estrada
 Universidad
Continental

I DATOS GENERALES
Nombres y Apellidos: _______________________________________

Edad: ____________________________________________________

Fecha de nacimiento: _______________________________________

Lugar de nacimiento: _______________________________________

Estado civil: ______________________________________________

Ps. David F.
Grado de instrucción: _______________________________________

Noreña Estrada
Ocupación: _______________________________________________

Nacionalidad: _____________________________________________

Religión: _________________________________________________

Dirección domiciliaria: ______________________________________

N° de Celular:_____________________________________________

N° de Celular de referencia:___________________________________
 Universidad
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II OBSERVACIÓN:

DESCRIPCIÓN FÍSICA:
Sexo : H M
Orientación : He Ho: _________________

Tipo constitucional:
Heath y Carter

Mesomorfico Endomorfico Ectomorfico

Edad que aparenta: ____________________Estatura Aprox.:_____________________________________
Estado General: ________________________________________________________________________

Ps. David F.
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Higiene:________________________________Estigmas:______________________________________

DESCRIPCIÓN DE ACCESORIOS:

Noreña Estrada
Vestimenta:____________________________________________________________________________
Objetos:______________________________________________________________________________

DESCRIPCIÓN DE CONDUCTA:
Actitud:________________________Relación con el entrevistador:_______________________________

Conducta No Verbal
Expresiones faciales: ______________________ Conducta postural:______________________________
Conducta gestual:__________________________________________________

Conducta Espacial
Intima personal social publica

Conducta Paralingüística
Tono:_______________________________________ Ritmo:____________________________________
Volumen:____________________________________ Silencios: _________________________________
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III MOTIVO DE CONSULTA

¿Cuál es el motivo de su consulta?
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IV PROBLEMA ACTUAL
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Ps. David F.
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Noreña Estrada
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V HISTORIA FAMILIAR
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____________________________________________________ Se recoge información sobre la
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familia de origen, información
de los padres, hermanos,
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mismo conflictos y situación de
salud familiar pasada y
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Ps. David F.
VI HISTORIA EVOLUTIVA
PRENATAL: __________________________________________________________________
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INFANCIA: ____________________________________________________________________
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Noreña Estrada
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NIÑEZ:_______________________________________________________________________
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ADOLESCENCIA:______________________________________________________________
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JUVENTUD:_______________________
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 Universidad
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ADULTEZ:____________________________________________________________________________
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Ps. David F.
Noreña Estrada
 Universidad
Continental

En esta parte es importante conocer las dificultades en

socialización y académicas, calificaciones, repitencias, evasión,
asignaturas complicadas y fáciles.

VII EDUCACIÓN
PRIMARIA:_____________________________________________
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Ps. David F.
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SECUNDARIA:_______________________________________________________________________

Noreña Estrada
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SUPERIOR:__________________________________________________________________________
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VIII TRABAJO
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Ps. David F.
IX CAMBIOS DE RESIDENCIA
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Noreña Estrada
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Se averigua sobre los tipos de trabajo, edad de inicio,

actual trabajo, problemas en el trabajo y repercusiones en
otras áreas.
En cuanto a cambios de residencia, salida del hogar sea
por estudios y/o trabajo (padres y/o el mismo) también
por llevar una vida sentimental (convivencia).
 Universidad
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X ACCIDENTE Y ENFERMEDADES
ACCIDENTE:_________________________________________________________________________
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ENFERMEDAD:_______________________________________________________________________
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XI VIDA SENTIMENTAL

Ps. David F.
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Noreña Estrada
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XII VIDA SEXUAL

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 Universidad
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XIII HÁBITOS E INTERESES

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XIV ACTITUD PARA CON LA FAMILIA

Ps. David F.
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Noreña Estrada
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XV ACTITUDES FRENTE A LA SITUACIÓN ACTUAL

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 Universidad
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XVI SUEÑOS
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Ps. David F.
Noreña Estrada