a) Your health condition(s)

List all current physical and mental health diagnoses (formal and informal), including the year it started. These should be listed starting with the most recent diagnosis and working backwards over time. The following is an example:

Health condition(s) or disability Year started
Depression 2020
Anxiety 2004
Fatigue - extreme tiredness 2000
EB Simplex Formally diagnosed in 1993 but present since birth

You do not need to expand on these in this question; you can do this in questions 3-15.

If you have not been diagnosed, explain why and list the primary symptoms associated with your condition(s). You will be asked to provide evidence to support your undiagnosed condition(s).


b) Your medication or treatment

List all paid-for and/or prescribed medications, tablets, treatments, therapies and dressings. It is helpful to include any additional prescribed medications you are not taking due to side effects.

You should also include any non-prescribed treatments and home remedies that help your condition, such as soothing footbath, silver socks or sitting in front of a fan to cool your feet.