A A Template For Get A Basic Self Health Check Up Right Now Online

Thanks for your purchase!  

Please read and follow all instructions below.  Once you have completed entering all of your answers on the Basic Self Health Check Up form, you will be able to print it out for your records, share with your friends and family, or simply compare it to changes with any future Self Health Check Ups.

If you have a specific health problem now, we recommend that you consider your next order to be a Specific Self Health Check Up with a more detailed questionnaire and Self Health Note of any particular problem for only $19.99.  You can then submit your selfie, to pin at the top of your Self Health Note.  

Please note that your selfie cannot be attached to the Basic Self Health Check Up, and can only be attached to a Specific or Complete Self Health Check Up, that will include a Self Health Note.

Our online self-health care system is a very convenient, online secure, and HIPAA-protected. This self health care online software program will immediately organize your health information today. Your consumer rights for electronic transmission of private and personal information online is very important to us, and so we protect your privacy rights by offering this secure and protected system online, in order to help you gather your health data safely and securely. 


What is a Basic Self Health Check Up?

A Basic Self Health Check Up allows you to enter your own health data on a fun-to-fill electronic health questionnaire, which asks you the same questions that your doctor would ask you at an office visit.  The difference is that YOU get to keep your own self-reported health note and store it for your own records, instead of leaving it at the doctor's office.  Separately, you can also order a low cost blood test online, nationwide and only in the USA, from anywhere and anytime with Self Health Care Online!

Once you have completed entering all of your answers on the Basic Self Health Check Up Form, you will be able to print it or download it for your records, or share it with your friends and family, or simply compare it to any changes to your health or any future orders of our Self Health Check Ups.


What's included?

  1. A Basic Self Health Check Up is a health questionnaire that is fun-to-fill, with a list of drop down menu answers.
  2. A self-reported, self-physical exam with the same questions that your doctor would ask you at a medical visit, but now you get to self-report to yourself.
  3. A copy of your own self-reported check up and health data that you can print or download now.

Note: This item does not include the 3D digital human interaction.  Please select a Basic or Complete Self Health Check Up And Play With YourSelf on your next purchase.

The Self Health Check Up questionnaire is located on a link down below.  


The Self Health Check Up questionnaire is located on a link down below, at the bottom of this page.  Please read the following instructions to assist you in completing this form.

Note: Any answers with long sentences will not be entirely visible within the small field boxes of the questionnaire, but the entire sentences will be visible in the printable version of the form, after you submit your questionnaire.

Enter as many answers that you can.  If you do not have all of your health data readily available, such as your vital signs, then enter your best educated guess. You have up to 10 days to complete and SUBMIT the questionnaire and then it will be deleted.  

Because this is a combined and discounted product with Play With YourSelf, if you do not SUBMIT the questionnaire, NO REFUNDS will be given after this purchase. 


How To Enter Your Health Data On The Questionnaire

Before starting your Self Health Check Up questionnaire, be sure to have the following basic information written down on a piece of paper for immediate entry.  If not, enter your best guess, or leave blank and skip to the next field box: 

  • Height ( in inches)
  • Weight (in pounds)
  • BMI or Body Mass Index (Use our BMI calculator for this value)
  • Temperature
  • Pulse Rate
  • Systolic Blood Pressure
  • Diastolic Blood Pressure

Need help?  Learn how to check your own vital signs.  Click Here


How To Enter Your Electronic Signature

To view the questionnaire form entirely, use the grey colored bar along the right side of your screen and scroll down, so that the top of this form is at the top of your screen.  This will allow you to see the Signature Box where you need to place your electronic signature.  Your signature does not need to be perfect, but it should be recognized by you.  

1)  Computer/Desktop user: Enter your best signature, using your mouse like a pen.  "Other Signature Options" to enter a digital signature is not available for computer/desktop users, and it is only used by cellphone/mobile users.

2)  Cell phone/Mobile users: Tap  "Other Signature Options" and then "Type-to-Sign" to enter your digital signature.  Handwriting your your signature may not be easy to do on a small signature line. 

3)  To reset your signature, click "Retry".

4)  When done, click "Preview Signature" to enter your signature.  Your signature will automatically appear on all of the other lines that require a signature, on every page. 

5) Be sure to follow the red tag cursor along the left side of the form, indicating if it is REQUIRED for you to complete the boxes, or else you will not be able to submit the form.  All other boxes are optional for you to fill in or leave blank.  


Troubleshooting the Questionnaire:


Refer to these instructions when filling out your health questionnaire.

1) The entire form is not visible.  

Solution: Scroll down on the shorter grey colored, right side bar, within the form.


2) I cannot sign the Signature Line.  Most common question by computer/desktop users.

Solution: Scroll down to the MIDDLE part of the web page moving the larger grey colored bar, located along the ride-side edge of your computer screen and find the signature box called. 


3) I have completed the questionnaire, but I cannot SUBMIT the form.  

Solution: There must still be a RED FLAG along one of the questions that you overlooked.  Look for the moving red tag, REQUIRED, along the left side of the form.  Be sure to check the following:

  • Enter your name and email address at the top of the form,
  • Enter all date boxes,
  • Enter the box describing the body part or health problem you purchased, and
  • Enter the very last question, Select One, located at the very bottom of the form, on the very last page.


After Completing Your Questionnaire

You will get an email with a copy of your Self Health Check Up questionnaire, so that you can print it out or download it, up to 10 days from purchase.  Your health information will be saved and entered into your account at the Healthy Check Up Portal.  

Please look for an email from customerservice@healthycheckup.com, where we will attach a temporary password that you will change and then get access to your Personal Health Records and Self Health Notes.  

Our safe and secure, Healthy Check Up Portal will allow you to communicate with us via electronic messages, where we can jointly send and receive any health related questions, health data or health notes, privately and securely online.  

We look forward to providing you the best self health care service online.  Please invite your family and friends to get a Healthy Check Up too!


Best wishes to you and we hope that you have a Healthy Check Up!


Click Here to Begin Your Basic Self Health Check Up Questionnaire