Assessment and Clinical Outcomes
The CORE-OM is used frquently in primary and hospital care to determine the needs of patients attending counselling and psychotherapy and to monitor their outcomes. The questionnaire is copyright CORE System Group (www.coreims.co.uk).

Please note: the contents of this form are confidential. Data is sent directly to me (only) and is NOT retained.

This is a free service for guidance only. It is NOT a substitute for professional advice, medical care or therapy with a qualified individual.

Note that for ethical reasons I cannot respond to submissions from non-UK domains and addresses. If you are outside of the UK I will NOT respond to your form. Sorry. Similar services exist in the US and other countries.
  • Please enter your name.
  • Please complete EITHER your name OR Client Code or else I will not know who completed this questionnaire. NB: May be left blank when not known
  • Please enter your current age
  • / /
    Please enter the date you complete this form

  • IMPORTANT – PLEASE READ THIS FIRST

    UK residents ONLY

    This form has 34 statements about how you have been OVER THE LAST WEEK.
    Please read each statement and think how often you felt that way last week.
    Then select the option which is closest to this.

  • Not at all Only occasionally Sometimes Often Most or all of the time
    1 I have felt terribly alone and isolated
    2 I have felt tense, anxious or nervous
  • Not at all Only occasionally Sometimes Often Most or all of the time
    3 I have felt I have someone to turn to for support when needed
    4 I have felt OK about myself
  • Not at all Only occasionally Sometimes Often Most or all of the time
    5 I have felt totally lacking in energy and enthusiasm
    6 I have been physically violent to others
  • Not at all Only occasionally Sometimes Often Most or all of the time
    7 I have felt able to cope when things go wrong
  • Not at all Only occasionally Sometimes Often Most or all of the time
    8 I have been troubled by aches, pains or other physical problems
    9 I have thought of hurting myself
    10 Talking to people has felt too much for me
    11 Tension and anxiety have prevented me doing important things
  • Not at all Only occasionally Sometimes Often Most or all of the time
    12 I have been happy with the things I have done
  • Not at all Only occasionally Sometimes Often Most or all of the time
    13 I have been disturbed by unwanted thoughts and feelings
  • Not at all Only occasionally Sometimes Often Most or all of the time
    14 I have felt like crying
    15 I have felt panic or terror
    16 I made plans to end my life
    17 I have felt overwhelmed by my problems
    18 I have had difficulty getting to sleep or staying asleep
  • Not at all Only occasionally Sometimes Often Most or all of the time
    19 I have felt warmth or affection for someone
  • Not at all Only occasionally Sometimes Often Most or all of the time
    20 My problems have been impossible to put to one side
  • Not at all Only occasionally Sometimes Often Most or all of the time
    21 I have been able to do most things I needed to
  • Not at all Only occasionally Sometimes Often Most or all of the time
    22 I have threatened or intimidated another person
    23 I have felt despairing or hopeless
    24 I have thought it would be better if I were dead
    25 I have felt criticised by other people
    26 I have thought I have no friends
  • Not at all Only occasionally Sometimes Often Most or all of the time
    27 I have felt unhappy
    28 Unwanted images or memories have been distressing me
    29 I have been irritable with other people
    30 I have thought I am to blame for my problems and difficulties
  • Not at all Only occasionally Sometimes Often Most or all of the time
    31 I have felt optimistic about my future
    32 I have achieved the things I wanted to
  • Not at all Only occasionally Sometimes Often Most or all of the time
    33 I have felt humiliated or shamed by other people
    34 I have hurt myself physically or taken dangerous risks with my health
  • Please tick one box to show the stage that you are at in counselling.
  • NON-CLIENTS: If you are completing this form on my website and you are NOT a client I need your email address. This is ONLY for the purpose of sending you your report. I will not use it for any other purpose. I will not contact you but you may contact me later if you wish.

    CLIENTS: If I know you already I don't need your email address - it's optional. Make sure you include your name or client number however.
  • Gender information is used to provide correct comparison data
Powered byEMF Survey
Report Abuse