Do you have any of the following conditions which have lasted, or are expected to last, at least 12 months

Deafness or partial hearing loss
Blindness or partial sight loss
A mobility or dexterity difficulty that requires the
use of a wheelchair
A mobility or dexterity difficulty that limits basic
physical activities (for example walking or dressing)
An intellectual or learning disability (for example
Down syndrome)
A learning difficulty (for example dyslexia)
Autism or Asperger syndrome
An emotional, psychological or mental health
condition (for example depression or schizophrenia)
Frequent periods of confusion or memory loss
(for example dementia)
Long-term pain or discomfort
Shortness of breath or difficulty breathing (for
example asthma)
Other condition (for example cancer, diabetes or
heart disease)
No condition