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Help with Non-Medical Support Services

At Cincinnati Children's, our goal is to achieve the best outcome for your child and to give you and your family the best possible experience. We have a wide range of services to help make your hospital visit as convenient and comfortable as possible. Please complete the information below to help us determine the services you may be eligible for. Thank you for considering Cincinnati Children's for your child's care and we look forward to serving you.

Patient Information

Can someone help me apply for resources?

Family financial advocates assist families that have health insurance but need additional financial resources to cover medical bills for their chronically ill child. We identify and help families apply for programs including Medicaid, Social Security, waivers, developmental disabilities services, Bureau for Children with Medical Handicaps (BCMH), and other financial assistance and family support resources. Our family financial advocates can also help you resolve billing issues.

For more information, contact our Family Financial Advocates at 513-803-6500 or email FFA@cchmc.org.

CCHMC MR # (if available)

* Patient's Name

* Date of Birth

Patient Gender

* Parent/Guardian Name(s)

* Parent/Guardian Email

* Primary Phone

Secondary Phone

Services Requested

Additional support services are available, please select any/all of these services below and the appropriate team member will contact you

Local hotel reservations (discounts and specials)

Complimentary transportation to/from airport

Shopping Services

Shipping Services

Local Area Attraction tickets

Dry cleaning and laundry (wash and fold) services

Other

Other Support Services

Our kind and caring staff will assist you with any questions you may have. Email: concierge@cchmc.org. Phone: 513-636-5009, or toll-free 1-888-894-1374.

Financial Assistance

* Referring Provider (if applicable, share which provider referred patient to Cincinnati Children’s for care)

Referring Provider Address

Referring Provider Location (City/State)

Primary Care Provider

By signing below and clicking submit, you are allowing Cincinnati Children’s to use the above information in order to improve patient and family experience and hospital operations. Click here to learn more about Cincinnati Children’s privacy policy.

* Electronic Signature (type your full name here to e-sign)

Record Type

Owner ID

Survey Name Hidden Field

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Help with Non-Medical Support Services

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