Your work capability questionnaire

This covers the Universal Credit health element and New Style ESA — they use the same assessment, so this one form serves both. It takes around 45–60 minutes.

What we're aiming for: there are two possible outcomes. "Limited capability for work" (LCW) means you don't have to look for work. "Limited capability for work and work-related activity" (LCWRA) means that plus a substantial extra monthly payment and no requirement to attend appointments or prepare for work. LCWRA is what we're aiming at, and it turns on how you describe your worst days.

The rule that decides most claims: can you do it reliably — safely, to a decent standard, as often as needed, and in a reasonable time? Doing something once, slowly, in pain, and then needing to recover is not being able to do it. Answer for how you are most of the time, not on your best day.

Please read if any of this applies to you: if working or preparing for work would put your health or safety — or anyone else's — at substantial risk, that alone can qualify you for LCWRA, regardless of points. This matters especially with severe mental health conditions, suicidal thoughts, epilepsy, or unpredictable collapses. There's a question about this near the end. Please answer it honestly, however hard it is.

About you

Full name Date of birth National Insurance number Postcode

Full address Phone number Email Which are you claiming? Do you have a fit note from your GP?

You need continuous fit notes throughout this process. If yours is running out, get another before it expires — a gap can stop your claim.

Your health conditions

Mental health counts exactly as much as physical health here — the mental function descriptors carry the same points. Never leave them out.

Other conditions, and when each started Medications, doses, and any side effects Do you have any hospital admissions, operations or appointments coming up?

Doctors and hospitals

Why this matters: the DWP may contact whoever knows you best. A GP who rarely sees you is far less use than a consultant, nurse or specialist who knows exactly how things are — so tell us about all of them.

Name of your GP

If you see a different doctor every time, just put "varies" — that's completely normal and it doesn't harm the claim.

GP surgery name, address and phone number How often do you see the GP? Hospitals or clinics you attend Consultants or specialists who know you Other professionals involved in your care

Their names and contact details, if you know them Any recent or upcoming hospital stays, operations or appointments?

Risk

This is the most important question on the form, and the hardest. Please answer it honestly — nothing here is judged, and it can change the outcome entirely.

Would being found fit for work, or having to prepare for work, put your health or safety at substantial risk?

Please tell us more, in your own words

If you're struggling right now, please don't wait for us — you can call Samaritans free any time on 116 123, or NHS 111 option 2 for urgent mental health support. We'd much rather you were safe than that you finished this form tonight.

A typical day

Describe an ordinary day for you, honestly — including the parts you'd normally keep to yourself. What time you get up, what you manage, what you don't, and what a bad day looks like. Assessors read this closely.

Anything else?

Send your answers

Press send and your answers come straight to us. We'll review everything, write up your full form, and be in touch — usually within one working day. Nothing goes to the DWP until you've approved it.

This form is a lot. Send what you've managed and we'll do the rest together — there's no rush and no pressure.