# Form Health, Inc. — Form D

Form Health, Inc. of Boston, MA, a company, filed a Form D exempt-offering notice with the SEC on 2021-04-28. The offering totals $12.0M, of which $11.1M was reported sold. Industry: Other Technology.

## Offering

- Filed: 2021-04-28
- Form: D
- Accession: 0001779388-21-000002
- Industry: Other Technology
- Exemptions: 06b
- Total offering: $12.0M
- Amount sold: $11.1M
- Remaining: $920K
- Investors: 5
- Date of first sale: 2021-04-13
- Security types: equity
- Revenue range: Decline to Disclose
- SEC file number: 021-397425

## Issuer

- Name: Form Health, Inc.
- CIK: 0001779388
- Entity type: Corporation
- Jurisdiction: DELAWARE
- Incorporated: 2019
- Address: 109 State Street, Boston, MA, 02109
- Phone: (617) 505-1520

## Officers, directors & promoters (5)

| Name | Role | Location |
| --- | --- | --- |
| Latif Peracha | Director | New York, NY |
| Evan Richardson | Director | Boston, MA |
| Evan Richardson | Executive Officer | Boston, MA |
| Evan Richardson | Promoter | Boston, MA |
| Juliette Bolea | Director | Brooklyn, NY |

## Other filings by this issuer (6)

| Filed | Form | Offering | Sold |
| --- | --- | --- | --- |
| [2025-04-15](https://search.stillhousedata.com/formd/0001779388-25-000002) | D/A | $43.0M | $43.0M |
| [2024-06-26](https://search.stillhousedata.com/formd/0001779388-24-000001) | D | $38.0M | $33.0M |
| [2023-11-06](https://search.stillhousedata.com/formd/0001779388-23-000002) | D | $8.0M | $6.7M |
| [2023-01-13](https://search.stillhousedata.com/formd/0001779388-23-000001) | D/A | $23.9M | $22.9M |
| [2022-10-14](https://search.stillhousedata.com/formd/0001779388-22-000001) | D/A | $22.0M | $19.7M |
| [2019-06-10](https://search.stillhousedata.com/formd/0001779388-19-000001) | D | $3.6M | $3.4M |

## More

- [CIK 1779388 on SEC EDGAR (source of record)](https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=1779388&type=&dateb=&owner=include&count=40)
- [This page as markdown (for LLM agents)](https://search.stillhousedata.com/formd/0001779388-21-000002.md)
- [Search all SEC filings, advisers and people on Adviser Search](https://search.stillhousedata.com/)

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