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Body & Soul Ministries  

A Private Health Ministry 

Member Intake Form 

Dear Member, 

We are pleased to offer you Body & Soul Ministries services. 

Included is a private membership in Body & Soul Ministries and Memorandum of Understanding/waiver  form for the health ministry caregiver. 

We thank you for your willingness to explore an alternative method of health and wellness. 

Body & Soul Ministries is a lawfully formed, faith-based Private Health Ministry, operating with a  reliance upon our faith in Nature and Nature’s God, dedicated to providing professional services and  advice concerning natural healthcare and services to its Members. The following forms explain this  relationship and the rights, benefits and responsibilities associated with membership. 

Thank you, 

The Body & Soul Ministries Administration
 

Body & Soul Ministries, A Faith Based Private Health Ministry Membership Agreement/Waiver Form 

Overview: I do hereby apply for membership in Body & Soul Ministries, hereafter termed “The Ministry,” a faith based private Health Ministry. With the signing of this membership agreement, I accept the offer made to become  a Member of The Ministry and have read and agree with the following Declaration of Purpose, Preamble and  Memorandum of Understanding. 

Declaration of Purpose: The primary work of Body & Soul Ministries is focused on educating and serving Body  & Soul Ministries Members so that they have all the latest knowledge in providing protocols, including but not  limited to Natural Healthcare, Holistic Healing Practices, Homeopathy, Body Work, Energy Work, Microcurrent, Laser, Emotional Clearing, Quantum Frequency Healing, creation and/or distribution of supplements, tinctures, ointments, salves, or any other natural form of healthcare practice to protect and improve the health of  Members; and provide access to Body & Soul Ministries protocols, including but not limited to protocols that  include homeoprophylaxis and other homeopathic preparations. Secondary work includes, but is not limited to: grassroots, political, and economic efforts to ensure the protection of our work. 

Membership: By consenting to the Membership Agreement provided, Members are granted the following rights  and benefits: 

● Right to detailed informed consent about the services rendered, and what to expect. 

● Complaints against a Body & Soul Ministries Member must be submitted in writing to Body & Soul  Ministries within three months of the incident of complaint. These will be sent to the Person, Committee,  or Tribunal designated by Body & Soul Ministries for evaluation and remediation action. 

● Upon request, access to the Ministry’s Bylaws. 

● Guarantee that all Personal Health Information (PHI) remain in the custody and in the confidential holding  of Body & Soul Ministries. Personal Health Information of all Members will be held in strict confidentiality  and will remain private from any State Medical Board, the FDA, FTC, Medicare, Medicaid or insurance  companies without the previously expressed specific permission granted by the Member. 

● Membership with Body & Soul Ministries will remain intact unless the Member submits in writing their  desire to withdraw membership or membership is terminated by The Ministry in accordance with bylaws.  

Preamble: We believe that the First Amendment of the Constitution of the United States of America, and the  Constitutions of the several States guarantee our Members the rights to religious liberties and freedoms and the  rights of free speech, petition, assembly, and the right to gather for the lawful purpose of advising and helping one  another in asserting our rights under law. IT IS HEREBY DECLARED that we are exercising our right of “freedom  of religion” and “freedom of association” as guaranteed by the 1st and 14th Amendments of the Constitution of the  United States of America and equivalent provisions of the various State Constitutions, which are excepted out of  the powers of general government. This means that our Ministry activities are restricted to private ecclesiastical  jurisdiction and are private matters. 

We proclaim the freedom to choose for ourselves the types of products, services, therapies, and self-help  modalities that we think best. We encourage our Members to perform their own research by studying different  resources to prevent illness and/or diseases of our minds and bodies and for achieving and maintaining optimum  wellness. We proclaim and reserve the right to include health options that include but are not limited to cutting  edge treatment modalities and therapies practiced or used by any types of healers or therapists or practitioners  the world over whether traditional or nontraditional, conventional or unconventional.  

Specifically, the mission of The Ministry is to change existing life and health circumstances through teaching  alternative health awareness, which enables Members to improve their physical well-being and to provide  Members with the highest-level services and of research and the most effective modalities for prevention. The  Ministry will recognize any person (irrespective of age, race, creed, gender, sexual orientation or religion) who has  been approved as a member and acts in accordance with these principles and policies as a Member and will  provide a medium through which its individual Members may associate for actuating and bringing to fruition the  purposes heretofore declared.                             

 

Memorandum of Understanding 

I, ___________________________________ understand that Members and service providers within  The Ministry are or may not be medical doctors. 

  • I understand that within The Ministry no doctor-patient relationship exists but only a contract  Member-to-Member association relationship. I have freely chosen to change my legal status as  a public person or patient, customer, or client to a Private Member of The Ministry. 

  • I understand that, since The Ministry is protected by the First and Fourteenth Amendments to  the Constitution of the United States of America, it is outside the jurisdiction and authority of  Federal and State Agencies and Authorities concerning any and all complaints or grievances  against The Ministry, any Trustee(s), Members or other staff persons. All rights of complaints or  grievances will be settled by a Ministry designee, committee, or tribunal and will be waived by  the Member for the benefit of The Ministry and its Members. By agreeing to this membership  form I agree that I have sought sufficient education to determine that this is the course of action  I want to take for myself and my children. 

  • Because the privacy and security of membership records maintained within The Ministry, which  are held to be inviolate by the Supreme Court of the United States, the undersigned Member  waives HIPAA privacy rights and complaint process. However, any medical or healthcare  records kept by Members of The Ministry will be strictly protected and only released upon  written request of myself as Member. 

  •  I agree that violation of any waivers in this membership contract will result in a no-contest legal  proceeding against me. 

  • The Ministry does not participate in any medical insurance plans or collections on behalf of the  Member but will provide a suitable invoice for the Member to pursue reimbursement by his/her  insurance company, if applicable. 

  • Other aspects of informed consent will take place in my discussions with the providers and my  fellow Members of The Ministry. 

  • As I am voluntarily choosing this method of natural health care, wellness, and disease  prevention, I will not hold The Ministry or its Members financially liable for any particular  outcome regarding my health.  

  • I agree to discuss my concerns with the Ministry Members and to seek appropriate medical  treatment, homeopathic or otherwise, should the need arise. 

I agree to join Body & Soul Ministries, a private membership health ministry under common law, whose  Members seek to help each other achieve better health and good quality of life. 

My activities within The Ministry are a private matter that I refuse to share with the State Medical Board,  the FDA, FTC, Medicare, Medicaid, or my own insurance company without my expressed specific  permission. All records and documents remain as property of The Ministry, even if I receive a copy of  them. I fully agree not to pursue any course of legal action against a fellow Member of The Ministry,  unless that Member has exposed me to a clear and present danger of substantive evil, and upon the  recommendation and approval of the Ministry. 

I enter into this agreement of my own free will without any pressure or promise of cure or disease  prevention. I affirm that I do not, or will not, as a Private Member represent any Local, State or Federal  agency whose purpose is to regulate and approve products, or to carry out any mission of enforcement,  entrapment or investigation and agree to accept membership in the capacity of Private Member. I have  read and understood this document, and my questions have been answered fully to my satisfaction. I  understand that I can withdraw from this agreement and terminate my membership in this Ministry at  any time, and that my membership can and will be revoked if I engage in abusive, violent, menacing,  destructive or harassing behavior towards any other Member of The Ministry. These pages consist of  the entire agreement for my membership in The Ministry.                                  

Payment of any dues, fees or program costs, if applicable and delivery of these signed documents to a  Ministry representative is considered sufficient for my one-time membership contract. Term begins with  the date of submission of this contract. 

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