Online Stay Requests

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Stay Request By Location

Guest Stay Request By Location


Patient Information


Has patient been exposed to any contagious disease?
Name of Treating Doctor
Other Patient Information


Guest Information

Contact Information

 I accept to receive text messages on this number

By checking this box I understand the following information is required
Have you stayed with us before?
Other Guest Information


Additional Information

Do you give RMHC permission to use any photos, artwork, or videos taken/created including the first name, age, and diagnosis of our child.
Are there any special needs for your family? (wheelchair, etc.)
Language Interpreter
Needed Language
Room Type

Notes regarding this request:



Acceptance
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