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.
Our neuropsychology program is designed to assess current cognitive function and/or capacity as it relates to cognition:
- Brain injury
- Stroke
- Dementia
- Multiple sclerosis
- Parkinson’s disease
Other common neuropsychological conditions
A referral is required from a ThedaCare or affiliate primary care provider.
Neuropsychology is offered at the following ThedaCare location:
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.
- Neuropsychology Appointment Information
- Neuropsychology History Form
- Informed Consent Neuropsychology
- Symptoms and Concerns – Self Report
- Symptoms and Concerns – Other Report
IMPORTANT
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.
