New Patient Forms

To help make the LCOHPA and Lindner Center of HOPE Admissions process as efficient as possible for you, online and printable patient forms and documents are available here. Forms can also be found and completed on MyChart.

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:  patient.records@lindnercenter.org
    • 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:  patient.records@lindnercenter.org
    • 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

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 12_2020

Download Lindner Center of HOPE Standard Charges

Download Lindner Center of HOPE Professional Associates Standard Charges

Download Machine Readable Lindner Center of HOPE Pharmacy Charges List July 2021

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: lcohregistration@lindnercenter.org

For further assistance, you can reach us at one of the numbers below.

Lobby Registration Direct Line: 513-536-0560