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Colegio Santa Rosa

Hermanas de la Providencia
Depto. Orientación y Psicología

FICHA ENTREVISTA APODERADOS/AS

Nombre de la Estudiante:____________________________________________________

Nombre del Apoderado:_____________________________________________________

Dirección:________________________________________________________________

Nº Telefónico:_______________ E-mail:_______________________________________

MOTIVO DE ENTREVISTA

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ANAMNESIS:

Embarazo:________________________________________________________________

Parto/Post Parto:___________________________________________________________

Temperamento:____________________________________________________________

Control de Esfínteres:_______________________________________________________

Colegio:__________________________________________________________________

Casa:_____________________________________________________________________
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ANTECEDENTES:________________________________________________________
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Colegio Santa Rosa
Hermanas de la Providencia
Depto. Orientación y Psicología

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Otros:____________________________________________________________________
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CONCLUSIONES O ACUERDOS
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Depto. Orientación y Psicología Firma del Apoderado

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