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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 a school, organization, or healthcare provider, please choose the name from the dropdown list below. Choosing an account allows Heads Up Checkup to aggregate de-identified (anonymous) data from your survey. Aggregated data is provided to schools and organizations to support and inform programs. Your personal health information (PHI) will be protected and your results will remain confidential. See Terms and Conditions below for HIPAA Privacy Notice and security.
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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.