Patient Forms

You can either email these forms to patient@cahopewell.com or print it out and bring it with you to your appointment. For new patients, please fill out the new patient packet AND the appropriate intake form.

If you have any questions about the form or the questions contained in the form, please feel free to contact us by email or phone and we will be happy to provide guidance in completing the form.

New Patient Packet

All patients are required to fill out this packet along with one of the appropriate evaluation intake form.

New Patient Packet

Assessment/Evaluation Intake Form - Adults

If you are age 18 or older, please fill out this intake form.

Adult Intake form

Entrevista de Adultos

Assessment/Evaluation Intake Form - Parent

If you are a parent of a child age 17 or younger, please fill out this intake form. Please note that we require children to be at least 6 years of age.

Parent Intake Form

Individual Records Request Form

Please note that your request is determined on a case by case basis and that Dr. Hopewell reserves the right to determine if an individual patient may receive psychological records or reports under Texas laws. To request a copy of your report, fill out the form and email it to: cahopewell@cahopewell.com

Individual Records Request Form

Release of Information Authorization Form

If you would like your report sent to another individual and/or organization, please fill out this form and email to: cahopewell@cahopewell.com

Release of Information Authorization Form

Patient Forms

New Patient Packet

Assessment/Evaluation Intake Form - Adults

Assessment/Evaluation Intake Form - Parent

Individual Records Request Form

Release of Information Authorization Form

Hopewell Neuropsychological Center