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Helping you cope and adapt to cognitive and behavioral changes.

(920) 720-2300

Understanding How Cognitive Change Impacts Behavior

Behavior can change as a result of disease, disorders or injury, and may begin to impact your ability to function. By way of properly assessing, diagnosing and treating certain brain-based conditions, it is possible to adapt – or even remediate – subsequent behavioral and mental changes.

ThedaCare Neuropsychologists assess the cognitive deficits resulting from a brain injury, stroke, dementia or any condition that impacts cognitive functioning. This allows us to accurately diagnose cognitive concerns, such as impaired thinking abilities or a lack of response to treatment.

Patient & Guardian Forms

Upon receiving a recommendation for neuropsychological care, there are two steps the patient and/or guardian must complete.

Step One:

Download and complete forms

The patient and/or guardian must download and complete the following forms in their entirety – don’t forget to save the file after you’ve completed them.
Please use the Chrome browser to access these forms.

  1. Neuropsychology Appointment Information
  2. Neuropsychology History Form
  3. Informed Consent Neuropsychology
  4. Symptoms and Concerns – Self Report
  5. Symptoms and Concerns – Other Report


If you prefer, mail or deliver the completed forms to:

ThedaCare Behavioral Health
1095 Midway Road
Menasha, WI 54952

Step Two:

Submit Completed Forms Online

Attach ALL 4 completed forms here and submit the online form to complete the process. All fields are required.

Drop files here or
Accepted file types: pdf, Max. file size: 999 KB, Max. files: 5.