QDM Wellness Assessment: Your Quantum Dive Begins Here Logo
  • QDM Wellness Assessment: Your Quantum Dive Begins Here

    Welcome to QDM! We're excited to guide you on your journey to optimal health. This questionnaire is designed to help us understand your unique wellness profile and recommend the most effective testing and coaching plan for you. Please answer the following questions honestly and thoughtfully.
  • Personal Information

  • Lifestyle Habits & Current Health

  • Wellness Goals & Preference

  • The Quantum Dive Method

  • PRIVACY NOTICE

  • The health information that you provide is under the protection of the federal Health Insurance Portability and Accountability Act (HIPAA). We can use your health information for purposes of treatment, payment and health care operations. Under HIPAA, you have the right to Request restrictions on how we use or disclose your health information in certain circumstances, including for treatment, payment or health care operations. We do not have to agree to your request unless you request restriction on disclosures to a health plan for purposes of payment or healthcare operations, and the health information relates to an item or service for which you, or another person on your behalf, have assumed full financial responsibility. If we do agree to your restrictions, we will be bound by our agreement except in limited circumstances, such as if there is an emergency.

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