Lindner Center of HOPE Professional Associates (LCOHPA)

Consent to Treatment-LCOHPA

Online Form or Printable File

NOPP- Notice of Privacy Practice Handout

Printable File

HIPAA- Acknowledgement of Receipt of Notice of Privacy Practice

Online Form or Printable File

Outpatient Practice Policy Guidelines

Online Form or Printable File

Financial Responsibility Agreement-Self-Pay-LCOHPA (based upon insurance)

Online Form or Printable File

Medicaid Waiver-LCOHPA (based upon insurance)

Online Form or Printable File

MDCR (ABN) Advance Beneficiary Notice

Brett C. Plyler, M.D.

Online Form or Printable File

Paul E. Keck, MD

Online Form or Printable File

Chris J. Tuell, EdD, LPCC-S, LICDC-CS

Online Form or Printable File

Megan T. Schrantz, Ed.D., LPCC

Online Form or Printable File

Peter White, M.A., LPCC, LICDC

Online Form or Printable File

Nutrition Services

Online Form or Printable File

Consent to Treatment-LCOHPA

Online Form or Printable File

NOPP- Notice of Privacy Practice Handout

Printable File

HIPAA- Acknowledgement of Receipt of Notice of Privacy Practice

Online Form or Printable File

Outpatient Practice Policy Guidelines

Online Form or Printable File

Verbal Release of Information

Online Form or Printable File

Authorization to Release-Documents

Online Form or Printable File

Financial Responsibility Agreement-Self-Pay-LCOHPA

Online Form or Printable File

Medicaid Waiver-LCOHPA

Online Form or Printable File

MDCR (ABN) Advance Beneficiary Notice

Brett C. Plyler, M.D.

Online Form or Printable File

Paul E. Keck, MD

Online Form or Printable File

Chris J. Tuell, EdD, LPCC-S, LICDC-CS

Online Form or Printable File

Megan T. Schrantz, Ed.D., LPCC

Online Form or Printable File

Peter White, M.A., LPCC, LICDC

Online Form or Printable File

Nutrition Services

Online Form or Printable File

Behavioral Health (BH) Financial Responsibility Agreement

Online Form or Printable File

Collection & Bad Debt Policy-LCOHPA

View Form

(Spanish) View Form

Late Cancellation No Show Waiver Request-LCOHPA

Online Form or Printable File

If you need assistance, please call:

Hospital Main Line: 513-536-HOPE
Lobby Registration Direct Line: 513-536-0560

If you are not using the online form completion option, completed documents may be sent by

Mail to:
Lindner Center of HOPE Registration
4075 Old Western Row Rd.
Mason, OH 45040

Lobby Registration Fax Line: 513-536-0648
Registration Email: lcohregistration@lindnercenter.org