Secure Intake Portal

Direct Care Agent Intake Portal

Submit your information below. A human agent will contact you within 24 hours.

Full Legal Name

Email Address

Direct Phone Number

WhatsApp Number

Employment / Work Status

Total Annual Earnings / Income ($)

Your Current Annual Revenue. This strictly helps our agents analyze long-term budget health and evaluate future repayment forgiveness potential.

Exact Total Medical/Dental Debt Owed ($)

I confirm and can demonstrate that I have 30% of this total debt amount ready, liquid, and available for settlement.

Number of Household Members Receiving Service

Compliance & Accountability Declaration

Restora Care Debt Relief never analyzes your medical history—our agents focus strictly on financial settlement coordinates. Once submitted, your data routes to a human agent who contacts you via phone, email, or WhatsApp. Funds are disbursed to your verified payment channels. Any intentional diversion of funds away from your designated healthcare provider will result in immediate legal prosecution for theft by trick and obtaining by false pretense by our localized enforcement networks.