IEP Nuestra Seora de las Gracias

Svieta Valia Fernandez Gonzlez, Psicloga

Departamento de Psicologa

FICHA DE ATENCIN A PADRES DE FAMILIA

Fecha de entrevista _________________________
1. DATOS PERSONALES
Apellidos

Nombres:

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Edad: ____________________
Telfonos:

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Nivel
Educativo:
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Centro de trabajo:_________________________

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Parentesco

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Nombre
del

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Nivel, Ao y seccin _________________________________
Consulta (
)
Citacin (
)
Otro(

Ocupacin:
Horario

de

trabajo:

Alumno

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2. MOTIVO DE ATENCIN
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3. FAMILIOGRAMA

4. DESCRIPCIN DEL PROBLEMA

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IEP Nuestra Seora de las Gracias

Svieta Valia Fernandez Gonzlez, Psicloga

Departamento de Psicologa

5. CONCLUSIONES
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6. SUGERENCIAS
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7. ACCIONES A TOMAR (I.E)
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DEPARTAMENTO DE PSICOLOGA