1- تحديد المشكلة أو الأضطراب :
*وصف المشكلة :
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
*الاعراض المصاحبة لحدوث المشكلة :
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
*مرات تكرار حدوث المشكلة :
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
*بداية حدوث المشكلة :
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
*الظروف التى تحدث فيها المشكلة :
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
*العوامل التى ساعدت على استمرار المشكلة :
1-عوامل فى محيط المدرسة :
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
2- عوامل فى محيط الأسرة :
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
3- عوامل فى محيط العلاقات الأجتماعية :
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
2- الاهداف التى يسعى الى تحقيقها الأخصائى النفسى:
1- .................................................. .................................................. .................................................. .................................
2- .................................................. .................................................. .................................................. .................................
3-.................................................. .................................................. .................................................. ..................................
4- .................................................. .................................................. .................................................. ................................
3- الاختبارات والمقاييس التى استخدمت مع العميل :
· اسم الأختبار : .................................................. .................................................. .................................................
· موضوعه : .................................................. .................................................. .................................................. ...
· تاريخ التطبيق : .................................................. .................................................. .............................................
· اهم النتائج : .................................................. .................................................. .................................................. ..
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
· اسم الأختبار : .................................................. .................................................. .................................................
· موضوعه : .................................................. .................................................. .................................................. ...
· تاريخ التطبيق : .................................................. .................................................. .............................................
· اهم النتائج : .................................................. .................................................. .................................................. ..
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
4- مصادر المعلومات :
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
5- طرق وأساليب الخدمة النفسية المقترحة :
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. ......................................
6- الطرق والأساليب التى تم اختيارها للتطبيق :
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. ......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
.................................................. .................................................. .................................................. .......................................
موضوع: 3-0سجلات الاخصائى النفسى 
الجمعة يناير 08, 2010 10:45 pm
