Secure Records Portal - Houston Neuropsychology Associates

The form below may be used to transmit medical and related records securely to our office.

Name of Record Provider*
Please enter your name (or the name of doctor or practice whom you represent).
First Last
Email*
Please enter your email address. You will receive an automatic confirmation message that the records were received.
Enter Email Confirm Email
File Upload*
The file(s) will be sent securely to our office.
Drop files here or

Accepted file types: pdf, doc, docx, odt, rtf, png, jpg, gif, xls, xlsx, Max. file size: 32 MB, Max. files: 5.
Additional Notes or Comments (optional)
Name
This field is for validation purposes and should be left unchanged.