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Please complete waiver form for yourself & your dependents (if applicable) for all services prior to your booking date. 

Consent/Waiver Form

Please fill out the following form.

Date of birth
Month
Day
Year
Have you been hospitalized in the last 12 months?
No
Yes
Are you suffering from a medical condition, illness or injury?
No
Yes

Where to Find Us

Text: (410)-205-5507

Call: (443)-402-1925

Fax: (213) 289-8532

Email: info@restorehealing.org

2120 Emmorton Park Road

Suite E

Edgewood, MD 21040

Mon - Fri: 8am - 8pm
​​Saturday: 8am - 7pm
​Sunday: 10am - 8pm

Office hours /staff admin phone support is from 8:30am to 2pm, Monday thru Friday. After 2pm and on weekends please use text line as there may not be someone to answer the phone.

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