Admissions Information / Referrals

Thank you for your interest in Youth Home, Inc. We are here to help your child and family through the difficult times you are experiencing.

Listed below are links to forms asking for some important information that we need. 

You may mail or fax these forms back to us at the address or fax number below. You may also mail or fax copies of any records, which you may already have, which will enable us to review your case even faster. We will keep you regularly informed as to the status of your case and welcome your calls to check in with us as often as you like.

Youth Home serves beneficiaries of all Provider-Led Arkansas Shared Savings Entities (PASSE). We also accept TRICARE® and other private insurance.

If you would like further information or have any questions, please feel free to call the Admissions Department at (501) 821-5500 or 1-800-728-6452.

If you are needing a mobile assessor please contact Tracy Caldwell, LCSW at (501) 554-0990 or This email address is being protected from spambots. You need JavaScript enabled to view it..

Thank you again for your consideration of Youth Home, Inc.

Mail, Email, or Fax Forms to:
Youth Home, Inc.
20400 Colonel Glenn
Little Rock, AR 72210-5323

Email: This email address is being protected from spambots. You need JavaScript enabled to view it. 

FAX: (501) 821-5582 

Please download the following documents, fill out, and return to Youth Home by fax or mail at the address provided above.

ADMISSIONS INFORMATION PACKET

The Letter of Recommendation Form for Therapists may be completed online by clicking HERE. 

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 our Admissions Information Packet.

Please also complete the following Electronic Authorization Forms if needed.

CONSENT TO E-MAIL COMMUNICATIONS

REQUEST FOR ACCESS FORM

AUTHORIZATION TO DISCLOSE HEALTH INFORMATION

AUTHORIZATION FOR DISCLOSURE TO YOUTH HOME

A list of allowed and prohibited items can be found on the What to Expect page.