Professional Documents
Culture Documents
1. Demographic Details
Name-
Age-
Address-
Education
Family Income
Parents-
Siblings-
Age of Siblings-
Gender-
Education/Occupation-
4. Personal History
Mother’s pregnancy and birth(optional)- time of birth, maternal stress, presence of both the
parents, normal or caesarean)
Early development (who raised the patient, were adults of both the sexes were present, were
they emotionally close to the you, description of your family life and surroundings)
Childhood-
Schooling and education (good or bad experiences, marks achieved by them, friends in school,
interaction with the teachers)-
Social circumstances-
Attitudes towards smoking-
5. Assessment of personality
Ultimate concern (What and who matters the most to you and why?)-