Patient referrals - our team can help.Fill out this form to start the process, or contact Dr. Ehlinger directly using phone or email. (513) 334-6974lina@lepsych.com Patient Information * First Name Last Name Email * Phone * (###) ### #### Patient needs help with: PTSD Borderline Personality Disorder Depression Anxiety/Panic Grief Substance Use Chronic stress/burnout Other (Please provide more information below) Patient prefers to be contacted by... Phone Email Text Referral Information * First Name Last Name Referral Company Type of Business Behavioral Health Psychiatrist or Prescriber Medical Doctor Hospital Other Referral Phone Number (###) ### #### Referral Email Reason for Referral Thank you!
