PROGRAMS | Quantum Transformation

BOOK A SESSION
PROGRAMS
- PROGRAM OF THE MONTH
- BENEFITS
QUANTA CAPSULE
FAQ's
- TESTIMONIALS
CONTACT
More

QUESTIONNAIRE

WHEN ANSWERING THESE QUESTIONS, PLEASE USE THE FOLLOWING SCALE:

1 - I don’t experience this or I experience this very infrequently
2 - I experience this to a small degree or very mildly
3 - I experience this about 2-3 times per week
4 - I experience this on a fairly regular basis
5 - I experience this daily or fairly severely

PAIN

I have back pain

1

2

3

4

5

I have neck pain

1

2

3

4

5

I have joint pain

1

2

3

4

5

My pain limits my daily activities

1

2

3

4

5

I have headaches

1

2

3

4

5

I have muscle aches

1

2

3

4

5

I suffer from overall body pain

1

2

3

4

5

I have migraine headaches

1

2

3

4

5

I experience physical pain on a daily basis

1

2

3

4

5

I need to take ibuprofen or another pain reliever on a regular basis

1

2

3

4

5

SLEEP

I have trouble sleeping soundly through the night

1

2

3

4

5

I have difficulty falling asleep

1

2

3

4

5

I wake up during the night and have trouble falling back to sleep

1

2

3

4

5

I do not wake up feeling rested

1

2

3

4

5

I often feel like I want to sleep more hours

1

2

3

4

5

I have sleep apnea

1

2

3

4

5

I sleep very lightly

1

2

3

4

5

I suffer from chronic insomnia

1

2

3

4

5

I take an over the counter sleep aid

1

2

3

4

5

I take a prescription sleep aid

1

2

3

4

5

Sleep more than 10-12 hours on some days

1

2

3

4

5

ENERGY

I feel like I don't have as much energy as I would like

1

2

3

4

5

I need coffee or tea to get going in the morning

1

2

3

4

5

Low energy affects me on a daily basis

1

2

3

4

5

I need energy drinks to sustain my energy

1

2

3

4

5

I don't feel I have enough energy to exercise

1

2

3

4

5

I feel good in the morning but my energy quickly dips

1

2

3

4

5

I experience a low in energy around 3-5pm in the afternoon

1

2

3

4

5

I get very tired after eating a meal

1

2

3

4

5

I would like to have more energy during the day

1

2

3

4

5

Having enough energy is an issue for me in my daily life

1

2

3

4

5

I feel more energized after listening to my frequencies every day

1

2

3

4

5

DIGESTION

My stomach is upset after a meal

1

2

3

4

5

I experience bloating on a regular basis

1

2

3

4

5

I take Tums or something similar on a regular basis

1

2

3

4

5

I have heartburn

1

2

3

4

5

My food does not seem to digest well

1

2

3

4

5

I find myself burping after a meal

1

2

3

4

5

I avoid fatty foods and do not tolerate them well

1

2

3

4

5

Having regular bowel movements is not common for me

1

2

3

4

5

My bowel movements tend to be loose

1

2

3

4

5

I suffer from constipation

1

2

3

4

5

I go to a hydro-colon therapist to clean my colon once a month

1

2

3

4

5

WEIGHT, APPETITE, AND BLOOD SUGAR

I feel that I need to lose weight

1

2

3

4

5

I crave sugary foods

1

2

3

4

5

I crave fatty foods

1

2

3

4

5

I have to eat many times during the day to keep my blood sugar stable

1

2

3

4

5

I find it difficult to exercise on a regular basis

1

2

3

4

5

No matter how little I eat, I cannot lose weight

1

2

3

4

5

I find it hard to follow a healthy food plan

1

2

3

4

5

I tend to eat well during the day, but eat unhealthy or excess in the evening

1

2

3

4

5

I am good on a diet for a while and then fall off of it

1

2

3

4

5

No matter how hard I try, I cannot lose the weight

1

2

3

4

5

BRAIN AND FOCUS

I find it difficult to focus my attention on tasks I need to do

1

2

3

4

5

My attention is easily lost to distractions

1

2

3

4

5

I find that it hard to retain information after I read or watch it

1

2

3

4

5

I would like to have more mental clarity

1

2

3

4

5

I forget sometimes why I walked into a room or where the keys are

1

2

3

4

5

I find that stimulants like coffee or energy drinks help me to focus

1

2

3

4

5

My memory is not as sharp as I would like for it to be

1

2

3

4

5

I find it hard to concentrate when I am trying to learn something new

1

2

3

4

5

Feeling hopeless, loneliness and sad everyday

1

2

3

4

5

Feeling better after listening to my frequencies

1

2

3

4

5

Feeling motivated after a virtual QBF balancing session

1

2

3

4

5

Experiencing brain fog in the morning

1

2

3

4

5

Experiencing brain fog in the afternoon after 3pm

1

2

3

4

5

MUSCLE FATIGUE AND STIFFNESS

Feeling whole body muscle fatigue in the morning

1

2

3

4

5

Feeling whole body muscle stiff in the morning

1

2

3

4

5

Feeling whole body muscle fatigue in the afternoon

1

2

3

4

5

Feeling whole body muscle stiff in the afternoon

1

2

3

4

5

Feeling upper body muscle fatigue in the morning

1

2

3

4

5

Feeling lower body muscle fatigue in the morning

1

2

3

4

5

Feeling upper body muscle fatigue in the afternoon

1

2

3

4

5

Feeling lower body muscle fatigue in the afternoon

1

2

3

4

5

Feeling upper body muscle stiff in the morning

1

2

3

4

5

Feeling lower body muscle stiff in the morning

1

2

3

4

5

Feeling upper body muscle stiff in the afternoon

1

2

3

4

5

Feeling lower body muscle stiff in the afternoon

1

2

3

4

5

Can't sit more than 10 minutes due to muscle fatigue and weakness

1

2

3

4

5

Can't walk more than 10 steps due to muscle fatigue and weakness

1

2

3

4

5

I declare that the info I’ve provided is accurate & complete

Thanks for submitting! We will evaluate and be in contact soon.

CONTACT ME

2403 Whipple Ave NW, Canton, OH 44708, USA

(440) 975-6646

M-F : 10AM-6PM SAT & SUN : 12PM-6PM

"Everything in life is vibration."

- Albert Einstein

QUESTIONNAIRE

Thanks for submitting!