Limitless Tribe Case Trial 7-Day Survey

You are being asked the same questions as the pre-trial Survey to see what changes you have experienced during the first 7 days. We have also included a "Success Statement" section at the bottom for you to provide positive results that we can potentially use.

The survey questions (besides your Success Statement) you complete will be kept confidential and will only be viewed by a select few Limitless Employees who are under a confidentiality agreement. If you feel uncomfortable sharing any of the below info, please skip the question and answer as many as you are comfortable with.

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* 1. General Information

Name

Age

Gender (Male or Female only please, this is science, not a social experiment)

Estimated Weight

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* 2. Do you experience any of the following:

	Never	Seldom	Sometimes	Often	Always
Stress	Stress Never	Stress Seldom	Stress Sometimes	Stress Often	Stress Always
Anxiety	Anxiety Never	Anxiety Seldom	Anxiety Sometimes	Anxiety Often	Anxiety Always
Anxiousness	Anxiousness Never	Anxiousness Seldom	Anxiousness Sometimes	Anxiousness Often	Anxiousness Always
Inability to sleep	Inability to sleep Never	Inability to sleep Seldom	Inability to sleep Sometimes	Inability to sleep Often	Inability to sleep Always
Inability to fully relax	Inability to fully relax Never	Inability to fully relax Seldom	Inability to fully relax Sometimes	Inability to fully relax Often	Inability to fully relax Always
Racing thoughts	Racing thoughts Never	Racing thoughts Seldom	Racing thoughts Sometimes	Racing thoughts Often	Racing thoughts Always
unsubstantiated fear	unsubstantiated fear Never	unsubstantiated fear Seldom	unsubstantiated fear Sometimes	unsubstantiated fear Often	unsubstantiated fear Always
Excessive fear	Excessive fear Never	Excessive fear Seldom	Excessive fear Sometimes	Excessive fear Often	Excessive fear Always
Tension and muscle stiffness	Tension and muscle stiffness Never	Tension and muscle stiffness Seldom	Tension and muscle stiffness Sometimes	Tension and muscle stiffness Often	Tension and muscle stiffness Always

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* 3. Do you experience any of the following:

	Never	Seldom	Sometimes	Often	Always
Excessive sadness	Excessive sadness Never	Excessive sadness Seldom	Excessive sadness Sometimes	Excessive sadness Often	Excessive sadness Always
Depression	Depression Never	Depression Seldom	Depression Sometimes	Depression Often	Depression Always
Suicidal thoughts	Suicidal thoughts Never	Suicidal thoughts Seldom	Suicidal thoughts Sometimes	Suicidal thoughts Often	Suicidal thoughts Always
Negative attitude towards many things	Negative attitude towards many things Never	Negative attitude towards many things Seldom	Negative attitude towards many things Sometimes	Negative attitude towards many things Often	Negative attitude towards many things Always
Thoughts that life has passed you by	Thoughts that life has passed you by Never	Thoughts that life has passed you by Seldom	Thoughts that life has passed you by Sometimes	Thoughts that life has passed you by Often	Thoughts that life has passed you by Always
Detached from family and social networks	Detached from family and social networks Never	Detached from family and social networks Seldom	Detached from family and social networks Sometimes	Detached from family and social networks Often	Detached from family and social networks Always

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* 4. Do you experience any of the following:

	Never	Seldom	Sometimes	Often	Always
Forgetfulness	Forgetfulness Never	Forgetfulness Seldom	Forgetfulness Sometimes	Forgetfulness Often	Forgetfulness Always
Scatter-brained	Scatter-brained Never	Scatter-brained Seldom	Scatter-brained Sometimes	Scatter-brained Often	Scatter-brained Always
Lack of focus	Lack of focus Never	Lack of focus Seldom	Lack of focus Sometimes	Lack of focus Often	Lack of focus Always
Unable to remember numbers or instructions	Unable to remember numbers or instructions Never	Unable to remember numbers or instructions Seldom	Unable to remember numbers or instructions Sometimes	Unable to remember numbers or instructions Often	Unable to remember numbers or instructions Always
Forget people's names	Forget people's names Never	Forget people's names Seldom	Forget people's names Sometimes	Forget people's names Often	Forget people's names Always

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* 1. General Information

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* 2. Do you experience any of the following:

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* 3. Do you experience any of the following:

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* 4. Do you experience any of the following:

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* 5. Please enter your Success Statement to include any positive results you have experienced that you are willing to share with the public.