Question 1a

Tell us in the space below:

  • what health condition or disability do you have?
  • the approximate start date

You don’t need to go into any detail about how your conditions affect you – you can add these details in questions 3 to 15.

You don’t need to be too specific about the date if you’re not sure – the year it started will be enough.

Example

Name of your condition or disability Approximate start date 
Agoraphobia 2012
Arthritis 2009

Question 1b

Tell us about tablets or other medication you are taking or will be taking and the dosage.

This includes anything you pay for yourself (for example, painkillers) as well as anything you’ve been prescribed.

If you’re not sure whether a tablet or medication is relevant, it’s best to include it anyway.

Write down how often you take each medicine, as well as the strength and dosage if you know it – for example “2 tablets, 50mg, 3 times a day”. You can find the strength on the packet or the patient information leaflet that comes with the medicine.

If you’ve got a printed prescription list you can attach this to your claim form – write your name and National Insurance number on it.

Side effects from medication

If you have medication to help you with side effects from another medication, you should include it.

Also, if there’s medication you should take but can’t because of the side effects you have, include it here too.

Example

Mary takes a pain-relieving tablet for arthritis and this tablet makes her feel sick. Her doctor prescribed her a tablet to stop her feeling sick.

Question 1c

Tell us about any treatments you have had, you are currently having or have planned for the future (include private as well as NHS funded treatments).
You’ll need to include:
  • when your treatment or therapy started or when it’s due to start
  • how often your treatment or therapy is
  • the dates of any operations you’re going to have
If you’re not sure whether a treatment, therapy or operation is relevant, it’s best to include it anyway. Include anything that you pay for yourself privately as well as anything you get from the NHS. Help with question 2: listing your health professionals Back to Help Filling in your PIP Claim Form