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Faithful Servant Ministries

Member Intake Form

Dear Member,

Good Vibrations Energy Center is a project of Faithful Servant Ministries, and we are pleased to offer you Faithful Servant Ministries services. Below is a Private Membership Application and Memorandum of Understanding/Waiver Form for Faithful Servant Ministries.

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

Faithful Servant Ministries is a lawfully formed, faith-based Private Health Ministry, operating upon our faith in Nature and Nature’s God, dedicated to providing professional services and advice concerning natural healthcare and services to our members. The following form explains this relationship and the rights, benefits, and responsibilities associated with membership.

Thank you, and welcome!

Faithful Servant Ministries Association

Faithful Servant Ministries Association

Faithful Servant Ministries, A Faith-Based Private Health Ministry Membership Agreement/Waiver Form

I do hereby apply for membership in the Faithful Servant 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 Faithful Servant Ministries is focused on educating and serving Faithful Servant Ministries members so that they have all the latest knowledge in providing protocols, including but not limited to Natural Healthcare, Holistic Healing Practices, Homeopathy, 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 Faithful Servant Ministries protocols and modalities.

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 Faithful Servant Ministries member must be submitted in writing to
    Faithful Servant Ministries within three months of the incident of complaint. These will be sent to the Person, Committee, or Tribunal designated by Faithful Servant 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 Faithful Servant 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 Faithful Servant 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 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 rights of “freedom of religion” and “freedom of association” as guaranteed by the 1st and 14th Amendments of the U.S. Constitution 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 an 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, 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 and use of specific energies and frequencies, 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 Ministry 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 U.S. Constitution, it is outside the jurisdiction and authority of Federal and State Agencies and Authorities concerning 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 U.S. Supreme Court, 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 heath.
  • 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 abide by the following terms for bringing a pet to Good Vibrations Energy Center should I decide to do so. 

Pet Terms & Conditions

  • Pets are welcome to receive EESystem sessions for $40 per 2-hour session in private reservations only, and they must be accompanied by their member caregiver.
  • Only well-behaved and house-trained pets can attend the chamber, but they must not get on the furniture. So please bring a bed or blanket for them.
  • Dogs must be on a leash at all times, and cats must be in a kennel or carrier. Contact us for other types of pets.
  • If your pet displays aggressive behavior, he or she will have to leave.
  • Pets who are prone to “mark their territory” with urine are not allowed.
  • Pets that claw, dig, or destroy furniture are not allowed.
  • All pets must be free of pests such as fleas, ticks, or worms, and a rabies vaccination must be current. If we determine your pet brings in pests with him or her, you will be responsible for all fumigation costs and our lost revenue from having to close for fumigation.
  • Your pet must leave the center in the same condition it was in when he or she arrived. You will be responsible for any repair of damages or extra cleaning required.
  • If you and your pet are required to leave for any violations, you will not receive a refund.

I agree to join the Faithful Servant 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.

Any guests that come with you who have not completed the membership process will need to do so at the center prior to receiving services. 

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