Quantum Vitality Life Balance Questionnaire

Personal Information

First Name

Last Name

Email Address

Quantum Vitality Life Balance Wheel

How Happy Are You Now in Each Area?

Rate yourself on how happy you are now in each area (from 1-10, where 1 is poor and 10 is optimal).

Relating to Body/Posture/Food/Exercise

Attitude/Emotions

Finances

Family/Intimate Relationships

Relating to People/Friends/Business

Spirituality

Career/Learning/Personal Growth

Creativity/Play/Recreation

Evaluate Your Life Balance

What are the Most Important Areas of Your Life?

Check only 3

Relating to Body/Posture/Food/Exercise

Attitude/Emotions

Finances

Family/Intimate Relationships

Relating to People/Friends/Business

Spirituality

Career/Learning/Personal Growth

Creativity/Play/Recreation

Your Top Goals

Please list your top goals for the 3 most important areas of your life

Thank you for completing the Quantum Vitality Life Balance Questionnaire!

Dr. Victoria Moore, DC, MA

Fulfilled in Relationship and Work

Victoria is amazing! She has been a catalyst for meaningful change and success in my life. I experience less stress, feel free-er in my body and have moved past emotional blocks to bring me to greater heights, both personal and professionally. I got married after 45 years of being single and am incredibly happy in my relationship. Plus, I am very fulfilled in my work as a trainer and coach at Decker Communications traveling around the world helping professionals influence others in their communication. Victoria’s work has helped me to thrive at my full potential.

Karen Laos
Karen Laos Consulting

Alert, Calm, Confident!

Thank you so much for today’s treatment. I feel so much better. With both the NET and Chiropractic I feel a significant structural shift. I feel like I have increased blood flow to my brain for the first time in decades! I’m alert, calm, confident. I feel an ease with my patients and writing which I’ve struggled with for years. In addition to feeling alert and calm, I’m also highly functional, even at 5 pm when I usually begin crashing. This is really working and I’m grateful.

Psychiatrist

“Dr. Victoria is a ‘master’ practitioner. She has helped me personally move past emotional fears and blockages that stood in the way of consciously creating my dreams coming true. It’s hard to believe change can happen so quickly, but with Victoria, it does. I highly recommend working with Victoria to quickly discover and change the emotional blockages that are stopping you from allowing your dreams to manifest!”

Boni Lonnsburry
Best selling author of “The Map – To Our Responsive Universe, Where Dreams Really Do Come True”

Achieve your goals with more ease

Run don’t walk to see Dr. Vic. She will support you in getting through your emotional blocks that you don’t even know you have, to achieve your goals with more ease. I have been going to see Dr. Vic for over 20 years and I know I would not have achieved the success I enjoy without her masterful support. I recommend her often and will continue to do so for years to come.

Caterina Rando
Master Coach for Women in Business

Transformation on Many Levels at Once!

Dr. Victoria Moore is an incredibly powerful healer who gets right to the heart of the challenge you have in an instant, and magically creates the space for transformation to occur on many levels at once.

I was amazed at what I experienced when I worked with her. Right after that I stepped powerfully into my truth and made a very important life changing decision that has, and will, affect my life and business forever: I reorganized my business model so I got back 100% control of my business, and now I make way more money.

Thanks Victoria! You rock!

Sean Stewart
Entrepreneur and Coach

Healing Mind and Body Together

You have to work with this woman. Dr. Moore is truly a healer. I have had an ongoing shoulder issue for years. Her wisdom and unique method of looking for the source of the problem have proved invaluable. I'm working out in the gym again, in a way I had not been able to do in years, thanks to the healing she has provided.

I can't even count how many other helpful practitioners I have been to over the years and none were able to pinpoint the way Dr. Moore did, the reason my shoulder wouldn't heal.

One of the most amazing aspects of Dr. Moore's work is the NET component. I had never even heard of NET before. Turns out it is a way of getting to the emotions underneath the injury. Guess what? If you don't heal the emotions, the injury doesn't heal! Working with Dr. Moore, the NET and other therapies has been such a gift in my life. Dr. Moore, I can't thank you enough.

Dot Spaet
Back Pain Specialist and Fitness Consultant

Less Stress, More Vigor and Energy in my Career

Working with Victoria, I experienced elegance and ease, joy and fun, less stress, greater vigor and energy in my career, more authentic relationships, and a more positive sense of Self. For the past 40 years, I have been a senior executive in the nonprofit field, dedicating myself to making a difference in the lives of others. But recently I realized that I also needed to make a greater difference in my own life – my emotional wellbeing, my experience of freedom, my connection to others, my ability to create.

Enter Dr. Victoria Moore, with her remarkable abilities as a Healer and Consultant. She not only helps me clear away the patterns and beliefs that are holding me back, she then also helps me generate new behaviors and ways for me to create what I really want in my life. Her insights, compassion and sense of joy and fun are supporting me in so many ways – to bring greater authenticity to my relationships, create a more positive self-image of who I really am (rather than who I sometimes think myself to be), reduce my stress level and experience greater vigor and energy in my career. She is a marvel, and working with her is one of the greatest gifts I’ve ever given myself.

Ted Howard
Senior Executive with Democracy Collaborative