Form Health, Inc. — Form D

Form Health, Inc. of Boston, MA, a company, filed a Form D exempt-offering notice with the SEC on 2023-11-06. The offering totals $8.0M, of which $6.7M was reported sold. Industry: Other Technology.

Offering

Filed: 2023-11-06
Form: D
Accession: 0001779388-23-000002
Industry: Other Technology
Exemptions: 06b
Total offering: $8.0M
Amount sold: $6.7M
Remaining: $1.3M
Investors: 3
Date of first sale: 2023-10-24
Revenue range: Decline to Disclose
SEC file number: 021-496525

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	D/A	$43.0M	$43.0M
2024-06-26	D	$38.0M	$33.0M
2023-01-13	D/A	$23.9M	$22.9M
2022-10-14	D/A	$22.0M	$19.7M
2021-04-28	D	$12.0M	$11.1M
2019-06-10	D	$3.6M	$3.4M

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