HEALING GOD MINISTRY
Spiritual, Mental, Phsical, and Social Healing
Customized and Confidential Self-Healing Treatments
510 Bailey Road Benton, TN 37307
1-817-877-1548
http://healinggodministries.atspace.org http://healinggodministries.atspace.org
Important: This health and nutrition evaluation is intended for educational purposes only, to assist the individual in learning how to preserve their own health. It is not the intention of this evaluation to diagnose or to prescribe any medication, treatment or modality for any physical or mental disorder, disease, ailment, complaint, or anomaly. Therefore any use of the information obtained from this health and nutritional evaluation, is at the sole discretion of, and in response to the direct request made by the individual whose name is signed on this form.
I hereby release all responsibility of Healing God Ministry and all staff from any possible harmful affects when accepting the Biblical life-style education.
Singnature: SS#: DATE:
Please complete entire questionnaire and return it to Healing God Ministry to be revieved by an health educator. After careful review, specific suggestions will be outlined for you in your search for better health using God's Plan. You will also receive a pamphlet that explains God's Rx Plan. Healing God Ministry is a ministry not a clinic. Therefore we provide this service through donations. Our goal is to be able to provide assistance to all needed persons, rich or poor. Your donations will help us achieve this goal. Please make a selection below and send any donation you choose below with the complete questionaire. (No credit card accepted. Make pasyments to Ron Bee**)
*Signup to be a Sponsor. Please choose your option below.
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Donate one time donation for this evaluation only. b