*Birthday

Gender

*Best results come from partnership. Are you willing to work closely with our nurse practitioners and staff, following the Take It Back Method? For lasting outcomes, plan on a minimum of 6 months of treatment — real change takes time and consistency.

*To ensure safe, effective care, members are seen every 4 months — or as directed by Joseph Debban, APRN, or Mariah Curtis, APRN — to monitor progress and adjust treatment. Are you willing to commit to these follow-up visits as part of your care?

*Our services are not billed through insurance. Working outside of insurance allows us to offer high-quality, personalized care with greater flexibility, transparent pricing, and lower overall costs. Is this a model you're comfortable participating in?

*Ongoing care at J Debban Wellness requires an active $75/month membership: quarterly visits, support, and discounted labs and supplements. This does not include primary care — patients should keep a primary care provider. Are you willing to be a member?

We ask for at least 72 hours' notice to cancel or reschedule your appointment. This allows us to offer that time to another patient. Appointments cancelled late or missed without notice will incur a $50 fee. Do you agree to this cancellation policy?

You will receive an email with important information and intake forms. All forms must be completed before your first appointment so we can get to know you and provide the best care. Are you able to receive emails and complete all forms before your visit?

*How did you hear about us?