ANAMNEZĂ

Nume şi prenume:____________________________________________________________
Vârsta şi sexul:_______________________________________________________________
Starea sănătăţii actuale:________________________________________________________
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Antecedentele heredo-colaterale (boli somatice şi psihice ale rudelor de gradul I şi II)
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Mediul familial anterior:______________________________________________________
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Mediul familial actual (atmosfera familială):______________________________________
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Mediul social anterior şi actual (cercul de prieteni):________________________________

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Nivelul de instruire:___________________________________________________________
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Date semnificative privind evoluţia psihică până la vârsta şcolară:____________________
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Date semnificative din perioada şcolară(succese, eşecuri):___________________________
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Date legate de profesie (evoluţie profesională, relaţii cu colegii, sefii, promovări):_______
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Modul de petrecere a timpului liber:_____________________________________________
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Idealul în viaţă, concepţia generală asupra vieţii:__________________________________
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