Living Health is providing a Woman's Health History fillable pdf form so I can understand your needs. The fillable form functions differently on various devices.
All devices will require an app that enables the form to be fillable.
Open or Download Woman’s Health History Form
On a desktop or laptop you will be able to submit to form merely by clicking "Submit Form"
On a mobile device, once you have filled in the form; you will need to email it to me at acLivingHealth@gmail.com.
You also have to option of printing out the form and mailing it to me at:
15 Laurel Place
West Caldwell, NJ 07006