This document contains an anamnesis form for music therapy, collecting information such as the patient's name, age, address, medical and psychological diagnoses, symptoms, family history, life events, relationships, and musical experiences. It gathers socioeconomic data, medical history, developmental history from childhood through adulthood, and current symptoms to help evaluate the patient and their suitability for music therapy. Non-verbal observations of the patient are also noted. The goal is to understand the full clinical picture for treatment planning.

1. Anamnese Musicoterápica
Nome:_____________________________________________________________________
________
Nome Social:
______________________________________________________________________
Idade:_____________ Sexo:_______________ Orientação Sexual:
_________________________
CPF:_________________________________
Identidade:__________________________________
Endereço:__________________________________________________________________
_______
Bairro:_________________________________
Cidade:____________________________________
Religião:______________________________
Escolaridade:________________________________
Cel
contato:____________________________________________________________________
____ Rede Social
:_______________________________________________________________________
__________________________________________________________________________
_________
Profissão:__________________________________________________________________
________
Est.Civil:___________________________________________________________________
________
Cônjuge (nome, idade, profissão,
escolaridade):________________________________________
__________________________________________________________________________
_________
Filhos (nome, idade e
sexo)__________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Tutor ou responsável: (nome, idade, profissão,
escolaridade):____________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Possibilidade de
horários:___________________________________________________________
__________________________________________________________________________
_________ Diagnóstico Médico:
________________________________________________________________
__________________________________________________________________________
_________
Diagnóstico Psicológico:
____________________________________________________________
__________________________________________________________________________
_________
Diagnóstico Diferencial:
_____________________________________________________________

2. __________________________________________________________________________
_________ Fez ou faz alguma terapia? (citar qual e
quando)________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Expectativas e objetivos do
paciente:_________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ Sintomas
apresentados:_____________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Patologias existentes ou pré-
existentes:_______________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Transtornos:
_______________________________________________________________________
__________________________________________________________________________
_________
Transtornos
familiares:______________________________________________________________
__________________________________________________________________________
_________
Patologias importantes familiares:
____________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ Eventos traumáticos de
vida:_________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ Relacionamentos Importantes
Conjuje:____________________________________________________________________
_______
__________________________________________________________________________
_________
Mãe:______________________________________________________________________
________
__________________________________________________________________________
_________

3. Pai:_______________________________________________________________________
________
__________________________________________________________________________
_________
Irmãos:____________________________________________________________________
________
__________________________________________________________________________
_________
Filhos:_____________________________________________________________________
________
__________________________________________________________________________
_________
Outros
importantes:________________________________________________________________
_
__________________________________________________________________________
_________
Observações sobre dinâmica familiar
atual:____________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Infância Gravidez (planejada ou não), parto, intercorrências
obstétricas:___________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Desenvolvimento infanto-
juvenil:_____________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Desenvolvimento
adolescência:______________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Vida adulta:
_______________________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________

4. Terceira idade:
_____________________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Comorbidades:
____________________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ Outros transtornos infantis (sono, alimentação, psicomotor, gagueira, tiques,
sonambulismo,
aprendizagem):______________________________________________________________
_______
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Outros
comentários:________________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Experiências afetivas
marcantes:_____________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Gosto esportivo
conflitante:__________________________________________________________
__________________________________________________________________________
_________
Círculo de
amizades:________________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ Situação
Financeira:________________________________________________________________
__________________________________________________________________________
_________
Observação e Linguagem Não verbal do Paciente
Observações:_______________________________________________________________
_______
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Grupo social e situação geográfica que vive:
__________________________________________

5. __________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ experiência musical
gestacional:_____________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Situação musical social/grupal:
______________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Experiência Musical
religiosa:________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Experiência instrumental:
___________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Gosto de( musica / estilo / musico ou grupo
Musical)___________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Experiência
instrumental:____________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ Rejeição a estilo / musica / som / instrumento:
_________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
Experiencial sonoro musical de vínculos afetivos:
______________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________

6. Gosto audiovisual (cinematográfico/ desenho animado/ clipes) relevantes: ________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ experiência tecnológicas:
___________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________ observações importantes:
___________________________________________________________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________
__________________________________________________________________________
_________

7. __________________________________________________________________________
_________