Heart 2 Heal Idaho Corp
Membership Enrollment Agreement
This Membership Enrollment Agreement (the “Agreement”) effective at the date last set forth below (“Effective Date”), is between Heart 2 Heal Idaho Corp, an Idaho Nonprofit Corporation with its principal offices located at Emerald St. Boise, ID 83704 ( “Heart 2 Heal”, “Us” or “We”), and
(“Patient” “Member” “You” or “Yours”) (Heart 2 Heal and You may be referred to individually as a “Party” and collectively as the “Parties”).
WHEREAS:
• Heart 2 Heal is a membership-based nonprofit ministry who see a need for a re-envisioned healthcare system;
• Heart 2 Heal is founded on the principle of an individual’s right to decide what is the best path to optimal health, through an uncoerced, voluntary and personal relationship with other members;
• Heart 2 Heal is committed to treating our Members with Christ-centered care, respect, gentleness, and love (Mark 12:31) regardless of age, race, religion, political views, disability or vaccination status;
• Heart 2 Heal desires to serve its Members in every aspect of wellness (preventative, mental, physical, emotional, and spiritual) by listening, educating, advising and ultimately honoring treatment decisions;
• Heart 2 Heal and You will mutually strive to promote, provide and protect the freedom to choose, render and receive the types of therapies and treatments that You deem best for diagnosing, treating, and preventing illness and disease and for achieving and maintaining optimum wellness;
• Heart 2 Heal is committed to treating our Members from a Christ-centered worldview, honoring the sanctity of life and the creation of male and female Children of God;
• the Parties agree that the cornerstone of this Agreement is physician and patient privacy and the enhancement and protection of the privileges of physician-patient confidentiality to the maximum extent possible;
In order to maintain the highest level of integrity to the above statements:
• You understand that Heart 2 Heal does not participate in any government-funded or private health insurance programs, HMO panels, or any other third-party payor health plans. Therefore, Heart 2 Heal may not bill or seek reimbursement from third-party payors for any of the Services included under this Agreement.
• You understand that Heart 2 Heal and staff have opted out of Medicare. Therefore, the law prohibits anyone from billing or seeking reimbursement from Medicare for any of the Services included in this Agreement. You agree not to submit bills or attempts to obtain reimbursement from Medicare for any such services.
• You understand that this your enrollment does not replace any existing health insurance or health plan coverage that You may carry. You acknowledge that Heart 2 Heal has advised You to obtain or keep in full force, health care coverage that will cover care and treatment not included in this Agreement, including but not limited to, specialty care, outside testing, surgeries, and hospitalization.
On behalf of You and Your family included on the enrollment information form, You agree to be above with this signature and date as a binding document.
By signing this form you are giving Heart 2 Heal consent to reach out to you via email and SMS (text) for appointment confirmations and marketing updates.