Limitless Tribe Case Trial Pre-Program Survey

The information 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.

	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

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

	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

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

	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

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

Limitless Tribe Case Trial Pre-Program Survey

Question Title

* 1. General Information

Question Title

* 2. Do you experience any of the following:

Question Title

* 3. Do you experience any of the following:

Question Title

* 4. Do you experience any of the following:

Question Title

* 5. Write one thing in your life that you would like to change in the next 30 days (less than 30 words please)

Question Title

* 6. Are you willing to commit to using the products and Breakthrough techniques as directed for at least 30 days?