RAK Your Life Application Form

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Thank you for your interest in Rak Your Life and working with Dr. Rak. You can learn about RAK Your Life membership options on our website.

If you are interested but need more info, please indicate this below, and our team will reach out.

Email *

Please enter your first and last name *

Please enter your phone number with area code *

What goals do you have that bring you here? *

Please select the option that best applies: *

I would like to join RAK Your Life as a Tribe member (weekly group health education calls)

I would like to join RAK Your Life as a Solo member (medical appointments with Dr. Rak, State Availability for Medical Visits: CA, TX, FL, NY, OH, ME, CO, PA, TN

I would like to join RAK Your Life as a Total member (weekly group health education calls+ medical appointment, State Availability for Medical Visits: CA, TX, FL, NY, OH, ME, CO, PA, TN)

I am interested but need more information. We will reach out to directly.

If you are interested in joining a RYL Tribe, indicate which of the following options: *

PLANT BASED TRIBE: Mondays at 430pm PST/730pm EST (Tribe is ready for you to join!)

HEART HEALTH TRIBE: Wednesdays at 1pm PST/4pm EST (Tribe is ready for you to join!)!)

MENS PEAK TRIBE: TIME TBD. Starting in early May!

None of these work for me, but I am interested in joining at Tribe. Our team will reach out.

N/A

Required

Would you like to be added to Dr. Rak's email newsletter, RAK ON? *

Yes, please add me to the mailing list

I am not interested at this time

Required

Please let us know any questions, comments, or specific interests you may have.

Send me a copy of my responses.

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