NUTRITIONAL HEALTH FORM
How to submit your health form
Option 1: Download and fill out the printable PDF form
Option 2: Fill out the online form below
Option 1: Printable PDF
Save the PDF to your computer first, then open it with a PDF reader like Adobe Reader or Apple Preview, fill it out, save it, and email it to firstname.lastname@example.org. Or you can print it out, fill it out with a pen, and bring it with you to your first appointment.
Do not fill out the PDF form in your web browser because it won’t save your responses.Raya Wellness Health Evaluation Intake Form — 623KB (PDF)
Option 2: Online Form
If you prefer, you can fill out the embedded Google form below.