Check-Up Checklist
Personal Information
Name: Ena Cassin
Email: ena@you.mail
Company Name: BluCurrent
Company Address: Louisville, KY 40201
Company Email: inquire@blucurrent.mail
Company Number: 222 555 7777
General Information
Item | Date Completed | Notes |
|---|
| January 15, 2050 | Appointment scheduled for 10:00 AM |
| January 15, 2050 | Confirm allergies and past surgeries |
| January 15, 2050 | List current medications |
| January 15, 2050 | Confirm details are accurate |
Physical Examination
Laboratory Tests
Test Name | Scheduled Date | Results Date |
|---|
| January 16, 2050 | January 18, 2050 |
| January 16, 2050 | January 18, 2050 |
| January 16, 2050 | January 18, 2050 |
Immunization Check
Screening Tests
Test Name | Date Scheduled |
|---|
| February 20, 2050 |
| February 20, 2050 |
| February 20, 2050 |
Follow-Up and Recommendations
Next Steps
If you haven’t scheduled your annual health check-up, take the first step today! Contact [YOUR COMPANY NAME] at [YOUR COMPANY NUMBER] or email [YOUR COMPANY EMAIL] to schedule your appointment. Your health is important, and staying proactive helps you live better and longer.
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