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Birthday
Month
Day
Year
I understand the Debban Men’s Optimization Program is $249/months after my $149 initial evaluation?
Yes
No
I understand that any treatment, including testosterone therapy, requires evaluation by a licensed clinician and is not guaranteed bases on this form?
Yes
No

We are a direct-pay (cash pay ) practice

Our services are not covered by insurance. By working outside of insurance, we are able to offer high-quality care at lower costs and with greater flexibility. Is this something you would like to participate in?
Yes
No

Before Your Initial Evaluation

You will receive an email with important information and intake forms. Completing these forms in advance helps us get to know you and provide the best possible care. Are you able to receive and complete the required forms prior to your appointment?
Yes
No
How did you hear about us?

Contact Us

4111 4th Ave. Suite 2

Kearney, NE 68845

Hours: 

Mon - Thur: 8:30am - 5pm

Fridays & Saturdays by appointment only

staff@jdebbanwellness.com

O. (308)293-0885 

F. (308)281-0841 

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