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
Revocation of Authorization to Release Information
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.
