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.
Thank you again for your consideration of Youth Home, Inc.
Mail or Fax Forms to:
20400 Colonel Glenn
Little Rock, AR 72210-5323
FAX: (501) 821-7709
Please download the following documents, fill out, and return to Youth Home by fax or mail at the address provided above.
For TRICARE® West Benificiaries please also complete the Application for Residential Treatment Center found on the Health Net website.
Please also complete the following Electronic Authorization Forms if needed.
A list of allowed and prohibited items can be found on the What to Expect page.