New Patient Forms
LCOHPA Outpatient Consent/Privacy Forms
The Health Information Management Department is glad to assist you with obtaining a copy of medical records from The Lindner Center of HOPE.
We need permission to process your request. Complete the Authorization for Release of Patient Protected Health Information form.
- For fastest service, choose Secure E-Mail for the Disclosure Method in section #5 on the form.
Send the form to us.
- For fastest service, email the authorization form to us.
-
- Email: [email protected]
- Fax: (513) 536-0219
- Mail:
Lindner Center of HOPE
Health Information Management
4075 Old Western Row Road.
Mason, Ohio 45040
Please allow 3-5 business days for a response to your request.
We do not have medical records for patients treated in the Cincinnati Children’s Hospital Medical Center Adolescent (CCHMC) care units at the Lindner Center of HOPE. Please contact Cincinnati Children’s. Phone (513) 636-4217 or fax (513) 636-6729.
Lindner Center of HOPE Non-Outpatient Consent/Privacy Forms
The Health Information Management Department is glad to assist you with obtaining a copy of medical records from The Lindner Center of HOPE.
We need permission to process your request. Complete the Authorization for Release of Patient Protected Health Information form.
- For fastest service, choose Secure E-Mail for the Disclosure Method in section #5 on the form.
Send the form to us.
- For fastest service, email the authorization form to us.
-
- Email: [email protected]
- Fax: (513) 536-0219
- Mail:
Lindner Center of HOPE
Health Information Management
4075 Old Western Row Road.
Mason, Ohio 45040
Please allow 3-5 business days for a response to your request.
We do not have medical records for patients treated in the Cincinnati Children’s Hospital Medical Center Adolescent (CCHMC) care units at the Lindner Center of HOPE. Please contact Cincinnati Children’s. Phone (513) 636-4217 or fax (513) 636-6729.
Financial Forms
IOP Services
Online Form or Printable File
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
Attention Self-pay and Uninsured Individuals
In accordance with the No Surprises Act, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call [1-877-696-6775].
View file
(Spanish) Printable file
May be subject to change.
May be subject to change.
At Lindner Center, we understand that the financial implications of mental illness can be difficult. We are available to discuss with you your financial obligations, insurance questions and payment options. In compliance with Federal and state law, Lindner Center is providing the required price transparency disclosures for our hospital (facility), professional and shoppable services. The charges are the same for all patients, but a patient’s responsibility may vary, depending on payment arrangements negotiated with individual health insurers.
These disclosures apply to Lindner Center services exclusive of Sibcy House or Williams House residential services. Lindner Center makes every effort to maintain these disclosures as charges and contracts change; however, under regulations is only required to update the information annually. As such, please refer to the effective date on the applicable spreadsheet for the last update.
This applies to Lindner Center of HOPE hospitalization and services not including Sibcy House or Williams House at Lindner Center of HOPE.
Download Lindner Center of HOPE cms shoppable services 9_2024
Download Lindner Center of HOPE Standard Charges 7 1 24
Download Lindner-Center-of-Hope-Professional-Associates-Standard-Charges-7 1 24
Download Machine Readable Lindner Center of HOPE Pharmacy Charges List 7_2024
Mail, fax, and email options
If you are not submitting the completed forms online, you may return them by mail, fax or email.
Mail to:
Lindner Center of HOPE Registration
4075 Old Western Row Rd.
Mason, OH 45040
Fax-to-Email line: 513-536-0648
Email: [email protected]
For further assistance, you can reach us at one of the numbers below.
Lobby Registration Direct Line: 513-536-0560