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Welcome to Heads Up Checkup Survey

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Please complete this registration form to receive a link to the Heads Up Checkup survey.




If you were referred by your school, your doctor, or other behavioral healthcare professional, please choose that name from the dropdown list below. By selecting the organization from the dropdown list, you are giving your consent to share your survey results with that organization.
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As soon as you click on the Submit Registration button below, you will receive an email or text within a few minutes that contains a link to the Heads Up Checkup survey. Once you complete the survey, you will receive an email with your results.