Admissions Information

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 forms asking for some important information that we need. You may provide this information by phone if you prefer. Also included is an authorization form for you to sign and an educational release form. The authorization will allow us to send to agencies for treatment records. The educational release is for us to send for school records and testing. These records should provide us with the necessary information for the screening process and for treatment of your child.

You may mail these forms back to us at the address below or FAX them to us at (501) 821-7709. 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:
Youth Home
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.

ADMISSIONS INFORMATION PACKET

LETTER OF RECOMMENDATION FORM FOR THERAPISTS

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

DONATE TO YOUTH HOME

Youth Home, Inc. is funded almost entirely by donations. To support our mission, you can make a donation online.

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Donate to Youth Home

While Medicaid covers a portion of the daily expenses for our 78 residential patients, there is still a shortfall that totals nearly $1.5 million per year.

Your gift reduces costs, allowing Youth Home to help those who need help the most and ensures that our programs are exceptional. Join our effort to change lives and save families.

Youth Home, Inc. is a 501(c) (3) non-profit organization. Eligible contributions are tax deductible.

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Contact Youth Home

Address:
20400 Colonel Glenn Road
Little Rock, Arkansas 72210 
MAP

PHONE: 501-821-5500

EMAIL: info@youthhome.org

Hours:
Monday-Friday: 8:30 am to 5:00 pm
Saturday-Sunday: Closed