Thank you for your interest in Youth Home, Inc. We know that seeking residential treatment can be a difficult decision to make. We are dedicated to providing your child and family with the best quality of care. Youth Home serves beneficiaries of all Provider-Led Arkansas Shared Savings Entities (PASSE). We also accept TRICARE®.
Below are links to our admissions form and other important information we will need. Please call our admissions team before completing any information if you have insurance other than Tricare or Arkansas Medicaid. Please reach out to us with any questions or if you are unable to complete these forms online and need copies mailed or faxed.
YOUTH HOME ADMISSION CONSENTS AND INFORMATION
LETTER OF RECOMMENDATION FORM (to be completed by Outpatient Therapist)
For TRICARE® West Benificiaries please also complete the Application for Residential Treatment Center found on the Health Net website. TRICARE® East Benificiaries only need to complete the Youth Home Admission Consents and Information found above.
Phone: (501) 821-5500 or 1-800-728-6452
Fax: (501) 821-5582 or (501) 821-5580
Thank you again for your consideration of Youth Home, Inc.