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.

Client Rights and Respon­si­bil­i­ties
Dere­chos y Respon­s­abil­i­dades del Cliente

Notice of Pri­va­cy Prac­tices
Avi­so de Prác­ti­cas de Privacidad

Health Assessment/​Medical History

Writ­ten Instruc­tions for Release of Infor­ma­tion & Records Request

To return forms by fax, please send to 8475850124.

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 8475248800 ext. 109.

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10%
of chil­dren in the U.S. strug­gle with seri­ous chal­lenges to their emo­tion­al and men­tal health.

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