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



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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 screening. 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 screening. Once you complete the screening, you will receive an email with your results.