First Name*
Last Name*
Email*
Type of Practitioner*
Years of Experience*
0-1
2-4
5-10
10-20
20+
Retired
What Are Your Goals With This Program?*
Cohort Dates (Pick One)
January 2025
April 2025
Location (time zone)*
Referred by (for example: QBC email, Carrie Bennett, Dr.Leland Stillman, ect.)
Why are you excited to study applied quantum biology?*
I understand that this is a practitioner training and is not the appropriate space for help with personal health problems*
Yes, I understand
No, this doesn't quite make sense to me
I understand that this certification teaches the foundational principles of Applied Quantum Biology that underpin human health *
Yes, I understand
No, this doesn't quite make sense to me
I understand that if I am new to the field of health and wellness, I will require some additional training, for example a coach training program*
Yes, I understand
No, this doesn't quite make sense to me
What questions do you have for us?*
Submit