Forms
The following are frequently needed forms for KYC clients and families. If a form you need is not provided here, please contact your therapist or case worker.
Notice of Privacy Practices
Rights and Responsibilities
Revocation of Release of Information
Formularios para clientes en español
Consentimiento para Servicios, Privacidad e Intercambio de Información
Aviso de Prácticas de Privacidad
Derechos y Responsabilidades del Cliente
To return forms by fax, please send to 847−585−0124.
To request your personal health record from Kenneth Young Center or if you are looking to have your records requested from Alexian Brothers Behavioral Health Hospital, Streamwood Behavioral Health System, Northwest Community Healthcare, or others, please call 847−524−8800 ext. 109.
