No.	Outcome Inventory-21
Name		Sex	Female	Male	Age	years
For the last week - including today, please describe your feelings in response to the statements, in terms of how often you experienced them (Circle the number that matches your feeling)		Never	Rarely	Occasionally	Frequently	Almost Always
There are a total of 21 statements		1	2	3	4	5
1	I experience physical pain across many parts of my body.
2	I believe that I cannot have a happy life - as others do.
3	I get bored with things easily.
4	I find it difficult to get to know other people.
5	I feel hopeless about my life.
6	I feel discomfort in my head and/or nose.
7	I feel pressured by the people or things around me.
8	I feel numbness or a tickling sensation.
9	I feel unhappy due to fear of specific things or situations.
10	I do not get along with others.
11	I am unable to concentrate while performing tasks.
12	I experience headaches.
13	I feel uncomfortable with people that are not family members.
14	I feel I have no goals in my life.
15	I worry about almost everything.
16	I like to be alone instead of being social.
17	I experience the shivers.
18	I feel depressed.
19	I hear a ringing/humming sound in my ears.
20	I cannot work or study as well as I should.
21	I have suicidal ideas.