Name
*
First Name
Last Name
Phone Number
*
Email Address
*
Birth Year
Would you like to tell us more?
*
How long you've had this issue, if you've ever seeked help, what you've tried to do...etc
About how often did you feel tired out for no good reason?
1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
About how often did you feel nervous?
1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
About how often did you feel so nervous that nothing could calm you down?
1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
About how often did you feel hopeless?
1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
About how often did you feel restless or fidgety?
1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
About how often did you feel so restless you could not sit still?
1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
About how often did you feel depressed?
1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
About how often did you feel that everything was an effort?
1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
About how often did you feel so sad that nothing could cheer you up?
1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
About how often did you feel worthless?
1. None of the time
2. A little of the time
3. Some of the time
4. Most of the time
5. All of the time
We will get back to you shortly, and someone from the Limitless Team will be contacting you by the next working day. Hang in there.
Our appointments are usually during business hours, Monday to Friday with limited time slots available in the evening.
If this is a crisis and you need help now, please call the following helpline - 1767 (SOS)