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History Submission

Welcome graphic

 
 
You can enter you history below for consideration of a "check-up"
 
Before you get too excited-- realize that I'm not a doctor. You'll need to read that below, and check "yes" that you understand this is just for fun and "yes" that I'm NOT a doctor.   If you're sick-- call 911, don't email me.  

About me:
Mid 30's, clean cut, attractive.
Discreet, "professional", regular guy.
 
 
What is used during the check-up?
 
If I'm traveling, I may not have everything with me-- if you are local, the following are available:
 
Otoscope to check ears
Flashlight for eyes
Single use tounge depressor
Cotton swab
Stethoscope for heart, lung, abdominal sounds
Blood pressure cuff
Single use medical gloves for prostate check
Sterile lubricant
Thermometer
Specimen cup
 
You may specific specific checks at the end of the survey.
 
How long does the exam take?
About 20-40 minutes, typically.  I'll stay clothed during the exam.
I'll guide you through the exam letting you know what I'm doing and what I
need you to do.  It's fairly straightforward.
 
Is my privacy assured?
Yes.   If done a few of these and my patients have been both straight or gay with concerns about privacy. 
 
Are enemas, shots, or blood involved?
No.
 
Why do you do this?
It's an exploration-- light, safe, fun.   Anatomy and the experience is interesting to me.  No more, no less.  I stay clothed during the checkup.
 
Does anything hurt?
No.    While everything may not be perfectly 'comfortable',
you can simply raise your hand if something bothers you.
 
If you're interested, fill in the form below.  When you click submit, it will be emailed. This isn't a spam site. You probably got here via CLonly to me.
 

This is a new addition to the site---
 
Have you had an Exam from me?  Let me know how it went..
Read what others said/thought..
 
 

How was it?

First Name
Email Address where you can be reached for confirmation
GenderMale
Female
Age
Reason for Checkup
Sexually ActiveYes
No
Sexual PreferenceStraight
Gay
Bisexual
Questioning
ExerciseExercise Daily
Never
3 times a week or more
Height
Weight
Body TypeAverage
Thin
Muscular
Overweight
About my body, I am...Shy
Not shy
Keep me covered please
Modest
Shy but
Hair ColorBrown
Black
Blond
What hair?
Red
Hair I have it all
Thinning
Shaved
What hair?
Eye Color
EthinicityWhite
Afroamerican
Asian
Hispanic
Rather not say
Overall, how do you feel?Good
Tired
Sad
Happy
Depressed
Any vision changes?Yes
No
Respiratory. Chronic cough?Yes
No
Any urinary problems?Yes
No
Do you do self monthly testicular exams?Yes
No
Penis length when soft
Penis length when erect
I am..
Day and Time of Last Ejaculation
Ejaculate Volume
Describe your sleeping habits..
Any special requests or areas of focus for the checkup?
When was your last checkup?
Not to ruin the experience, but I understand this exam is for fun only--Yes
No
I understand the 'doc' is not a doctor.Yes
No
When do you prefer to schedule?
What city are you in?
Where can we perform the checkup?
If circumsized, when did you have it done?
Indicate below, what needs to be checked/performed
Everything, if necessary
Head/Neck/Eyes/Nose/Throat/Ears/Nose/Throat/Ears
Chest/Abdomen
Pulses/Blood Pressure
Balance and General Strength
Temperture-Oral
Penis/Scrotum/Testicles
Measurements
Temperature-Rectal
Prostate
Urine Sample
Semen Sample
I want to be catheterized for urine sample (sterile, single use tube lubricated and insterted into penis)
I do not want a catheter.
Please, also check/erpform the following:
Any Questions/Comments/Suggestions