Records Request

To provide consent to BHSA to correspond with you via email, please complete the form below:

CONSENT TO E-MAIL COMMUNICATIONS

To request access to your BHSA records, please complete the form below:

REQUEST FOR ACCESS FORM

To provide authorization for BHSA to disclose your protected health information to another entity, please complete the form below:

AUTHORIZATION TO DISCLOSE HEALTH INFORMATION

To provide authorization for another entity to disclose your protected health information to BHSA, please complete the form below:

AUTHORIZATION FOR DISCLOSURE TO BHSA

Request an Appointment

Fill out our online request form and someone will be in touch to schedule your appointment.

Make A Request

before your first visit

Prepare for your appointment with our checklist of items to bring.

learn more

DONATE TO BHSA

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

donate

Request An Appointment

If you would like to request an appointment, please click the button below and fill out the form. If you need to contact us, please click here

REQUEST AN APPOINTMENT

If you are having a medical emergency, please use a phone to dial 911.

Contact BHSA

If you have questions or comments, please feel free to use the information below to reach out to us. 

Address:
10 Corporate Hill Drive, Suite 330
Little Rock, Arkansas 72205
MAP

PHONE: 501-954-7470
FAX: 501-954-7420
EMAIL: info@bhsarkansas.org

Hours:
Monday-Thursday: 8 am to 6 pm
Friday: 8 am to 5 pm