Your journey towards healing and hope begins here.

Please download the file to complete the required form, and email it back to info@restoredhearts.org.

01

HIPPA

Complete this form to ensure privacy.

02

Consent Form

Complete this form to verify your understanding of the nature, risks, and benefits of treatment.

03

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“And the God of all grace, who called you to his eternal glory in Christ, after you have suffered a little while, will himself restore you and make you strong, firm and steadfast.”