Private Membership Association Agreement

New Health Options
(A Private Healthcare Membership Association)


MEMBERSHIP CONTRACT


I, _________________________________________, for membership fee paid in hand, do hereby apply
for membership in New Health Options, a private healthcare membership organization. With the signing of this
membership agreement I/we accept the offer made to become a member of New Health Options and have read
and agree with the following Declaration of Purpose from Article I of New Health Options Articles of
Association.
1. This Association of members hereby declares that our main objective is to protect our rights to
freedom of choice regarding our health information and care, through maintaining our Constitutional rights.
2. As members, we affirm our belief that the Constitution of the United States is one of the best
documents ever devised by man and the signers of the Declaration of Independence did so out of love for
their country. We believe that the First Amendment of the Constitution of the United States of America
guarantees our members the rights of free speech, petition, assembly, and the right to gather together for the
lawful purpose of advising and helping one another in asserting our rights under the Federal and State
Constitutions and Statutes. We strive to maintain and improve the civil rights, constitutional guarantees,
and freedom of choice in health care and political freedom of every member and citizen of the United
States of America.
3. We declare the basic right of all of our members to select spokesmen from our number who could
be expected to give wisest counsel and advice concerning the need for physical and mental health care
assistance and to select from our membership those members who are the most skilled to assist and
facilitate the actual performance and delivery of care and suggest products, electronic instruments and
subtle energy devices.
4. We proclaim the freedom to choose and perform for ourselves the types of modalities that we
think best for achieving and maintaining optimum wellness of our minds and bodies. We proclaim and
reserve the right to include health options that include but are not limited to cutting edge modalities
practiced or used by any types of healers or practitioners the world over whether traditional or
nontraditional, conventional or unconventional.
5. More specifically, the mission of our Association is to provide members with the highest level of
quality care and the most effective methods of care. Our Association understands that wellness has many
dimensions and strives every day to stay on the leading edge of new products and technology. The
Association provides advanced products and technologies for assessing a member’s health and provides the
most effective care at an affordable fee. More specifically, the Association specializes in the selling of food
supplements and other products on the wholesale and retail markets and offers electronic instruments to
these markets as alternates to medication concerning the modalities of service and benefits to members.
6. The Association will recognize any person (irrespective of race, color, or religion) who is 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 theretofore declared.
MEMORANDUM OF UNDERSTANDING
I understand that the fellow members of the Association that provide education and care do so in
the capacity of a fellow member and not in the capacity as a licensed health care provider. I further
understand that within the association no doctor-patient relationship exists but only a contract member Association relationship. In addition, I have freely chosen to change my legal status as a public
patient to a private member of the Association. I further understand that it is entirely my own responsibility
to consider the advice and recommendations offered to me by my fellow members and to educate myself as
to the efficacy, risks, and desirability of same and the acceptance of the offered or recommended program,
care and products is my own carefully considered decision. Any request by me to a fellow member to
assist me or provide me with the aforementioned care is my own free decision in an exercise of my rights
and made by me for my benefit and I agree to hold the Trustee(s), staff and other worker members and the
Association harmless from any unintentional liability for the results of such care, except for harm that
results from instances of a clear and present danger of substantive evil as determined by the Association, as
stated and defined by the United States Supreme Court.
The Trustee and members have chosen Dr. John A. Tafel as the person best qualified to perform services
to members of the Association and entrust him to select other members to assist him in carrying out that
service.
In addition, I understand that since the Association 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 any and all complaints or grievances against the Association, any Trustee(s),
members or other staff persons. All rights of complaints or grievances will be settled by an Association
Committee and will be waived by the member for the benefit of the Association and its members. Because
the privacy and security of membership records maintained within the Association which have been held to
be inviolate by the U.S. Supreme Court, the undersigned member waives HIPAA privacy rights and
complaint process. Records kept by the association will be strictly protected and only released upon
written request of the member. I agree that violation of any waivers in this membership contract will result
in a no contest legal proceeding against me. In addition, the Association does not participate in any
medical insurance plans or collections on behalf of the member.
I agree to join the Association, a private membership association under common law, whose members seek
to help each other achieve better health and live longer with good quality of life.
I understand that the providers who are fellow members of the Association are offering me advice, services,
and benefits that do not necessarily conform to conventional medical care. I do not expect these benefits to
include on-call coverage, hospital care, or the usual and customary care provided by most physicians. I
will receive such primary and specialist care elsewhere. I fully understand that the benefits I receive from
Association are probably not covered by my health insurance and not at all by Medicare.
As a member, I accept the goals of helping my body function better and choosing techniques that are both
very safe and have a reasonably good chance to succeed, realizing that no evaluation technique or remedy
is foolproof. If I choose to forgo drugs, surgery, or radiation that has been recommended to me by others, I
fully accept the risk that I might suffer serious consequences from that choice. Other aspects of informed
consent will take place in my discussions with the providers and my fellow members of the Association.
My activities within the Association are a private matter that I refuse to share with the State Medical Board,
the FDA, Medicare, Medicaid or my own insurance company without my expressed specific permission.
All records and documents remain as property of the Association, even if I receive a copy of them. I fully
agree not to file a malpractice lawsuit against a fellow member of the Association, unless that member has
exposed me to a clear and present danger of substantive evil. I acknowledge that the members of the
Association do not carry malpractice insurance.
I enter into this agreement of my own free will or on behalf of my dependent without any pressure or
promise of cure. I affirm that I do not represent any state or federal agency whose purpose is to regulate
the practice of medicine. 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 Association at any time. These pages and Article I of the Articles of Association of the
Association consist of the entire agreement for my membership in the Association, and they supersede any
previous agreement.
I understand that the membership fee entitles me to receive those benefits declared by the Trustee(s) to be
“general benefits” free of further charge. I agree to pay as levied those benefits that I receive that are
declared by the Trustees to be “special assessments”, per Fee Schedule.
I enclose the sum of $10.00 as consideration for my lifetime membership contract, said term beginning
with the date of the signing of this contract, and by these presents do hereby certify, attest and warrant that
I have carefully read the above and foregoing New Health Options Contractual Application for Membership,
and I fully understand and agree with same.

IN WITNESS WHEREOF I set my hand this ______day of _____________________, 20____.

 

________________________________________________________________________
Member’s Name (Please Print Legibly) (…and name of legal guardian if applicant
under 18 years)


________________________________________________________________________
Member’s Signature (and signature of legal guardian if applicant under 18 years)


Member’s Address and Phone #:


__________________________________________________
Street
Apt. #_________
_______________________________
City, State, Zip Code
_________________________________________________
Home Phone #
_________________________________________________
Work Phone #
__________________________________________________
Cell Phone #
New Health Options


By________________________________________________
Approved and accepted this ____________ day of ________________________, 20___.

Mail to: New Health Options

5000 Old Shepard Place Ste. 722

Plano, TX   75093

Comments are closed.