Checkup List

Health & Body Checkup List


*this form will be filled by the respondent's on his/her own will
*to be noted that all information provided will be private and confidential
- provide the newest updates according to the following year
- the information provided should be accurate and near to precise measurements
- cheating or providing fake information is strictly forbidden
- if the respondent is not willing to fill this form, contact the sender
- if there is any questions regarding to this form, do contact your sender immediately
- strongly suggested that the respondent read through this form from the beginning to the end before answering the questions in this form

(this form is personally and officially prepared by Suki, not for other purposes/uses)

To contact your provider click here

copyrighted to Suki 2009
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Section A: Normal Appearances


Height (in cm) :

Weight (in kg) :

Hair color natural ; dye :

Eye color natural ; contact lens :

Skin color natural ; toning :

Facial hair (yes or no) :

Hairy (yes or no) :

Ear lobes (attach/detach) :

Number of teeth :

Chin (single/double) :



Section B : Body Measurements
Lengths (in cm)

Neck (circumference) :

Chest (circumference) :

Shoulder (diameter) :

Arm (circumference) :

Elbow (circumference) :

Wrist (circumference) :

Waist (circumference) :

Hip (circumference) :

Thighs(circumference) :

Knee (circumference) :

Dick inner circumference (thickness) :
length (when erect):
circumcised (yes/no), if yes when and why :

Buttocks (flat/round) :

Feet (length) :



Section C: Sizes (state if it is based on UK/US/Asian/other size below this line)
based on : ___________ (state N/A if not applicable)

Shirt :
Pants :
Shoe :
Bra :
Panty :
Boxer :
Socks :
Gloves:



Section D: Sensory Organs Choose one (delete others)


1)Eyes : Short/Long sightedness/Color Blindness/Perfect Vision/Others (state it)

2)Ears : Deaf/Hearing problems/Perfect Hearing/Others (state it)

3)Nose : normal/having breathing difficulties

4)Tongue : normal/having tasting difficulties

5)Skin : sensitive skin/scaly dry skin/others (state it)

Other disabilities (state if any) :
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Section E: Question and Answer

Extra information


1. Do you shave (facial) If yes, how often

2. Do you shave (pubic area) If yes, how often

3. Bad breath (yes/no)

4. Body smells (yes/no)

5. Urine Color (normally)

6. Feces Color (normally)

7. What do you eat normally :
- Breakfast
- Lunch
- Tea
- Dinner
- Supper

8. Marriage (yes/no), why

9. Kisses anyone before? (if yes, when/who/why/where)

10. When was it when your pubic hair grows, which part first

11. When's your first time Cumming

12. When's your first time putting something into your anus

13. Do you ever drink/smoke/drugs/gamble?

14. When did you find that you are submissive

15. Do you think that being submissive is mentally healthy

Additional :
*state or provide any additional answers/questions/comments/thoughts that you feel like sharing with me.
*to be noted that this additional section is a feel free to share and ask section, need not feel shy or worried that I'd be offended or have bad impression towards you