Fillable Printable Genogram Example Template

Genogram Example Template

Appendix 7

Genogram example

Genogram symbols

Male Female Gender unknown Death

(e.g. pregnancy)

Genogram symbols

Enduring

relationship

(marriage or

cohabitation)

Separation

Transitory

Relationship

Divorce

First child Second child Miscarriage or Twins

abortion

A dotted line should be drawn around the people who currently live in the same house.

Significant people in a child’s life should be shown and dotted lines to these

Dated 01/10/2012