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.

Apps for Devices

Desktop, Laptop - Adobe Acrobat Reader
iOS - Adobe Fill & Sign
Android - Adobe Fill & Sign

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:
Living Health
15 Laurel Place
West Caldwell, NJ 07006

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