Longevity Sign Up | J Debban Wellness

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By completing this form, you are authorizing Debban Wellness to charge $1,400.00 to the credit or debit card currently on file with our practice for the annual Longevity Program testing bundle.

This fee covers your complete testing kit, shipping, lab processing, and your Longevity Scorecard review at your next scheduled visit. Your kit will be ordered and shipped to your address on file within one to two business days of payment processing.

This authorization is for a one-time annual charge. Renewal for subsequent years will require a new authorization. If you have any questions before authorizing, please call Jill at 308-293-0885 before submitting this form.

I authorize Debban Wellness to charge $1,400.00 to my card on file for the Longevity Program annual testing bundle described above.

I confirm that my name, contact information, and shipping address on file with Debban Wellness are current and accurate. If my address has changed, I will contact the clinic before submitting.

I understand that testing kits require approximately four weeks to return results from the date the lab receives my sample, and that results will be reviewed at my next scheduled visit.

Type your full legal name below. This serves as your digital signature authorizing the enrollment and payment described above.

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