As a 10-year follow up to our original study (Rabin, Barr, & Burton, 2005), we surveyed the test usage patterns of clinical neuropsychologists in the U.S and Canada. We expanded the original questionnaire to include additional cognitive and functional domains and to address current practice-related issues. Participants were randomly selected from the combined membership lists of the National Academy of Neuropsychology and the International Neuropsychological Society. Respondents were 512 doctorate-level members (25% usable response rate; 54% women) who had been practicing neuropsychology for 15 years on average. The Wechsler Adult Intelligence Scales, followed by the Wechsler Memory Scales, Trail Making Test, California Verbal Learning Test, and Wechsler Intelligence Scale for Children, were the most commonly used tests. These top five responses were identical and in the same order as those from 10 years ago. Participants respectively identified a lack of ecological validity and difficulty comparing the meaning of standardized scores across tests as the greatest challenges associated with the selection of neuropsychological instruments and interpretation of test data. Overall, we found great consistency in assessment practices over the 10-year period. We compare results to those of previous studies and discuss challenges and implications for neuropsychology.