FillMyPIPPIP2 form planner · www.fillmypip.co.uk/pip2-practice-sheet
Home / Free tools / PIP2 form planner
Free printable planner

PIP2 form planner: every question in order

This is not the DWP form and cannot be sent. Your PIP2 comes by post (or as an emailed link to fill in online) after you start your claim, usually by phone. Send it back within the date on the letter: gov.uk says you have 1 month, and you can call the PIP enquiry line if you need more time.

Every question on the PIP2, in the order the form asks it, with room for your notes. Fill it in on screen or print it, then copy your notes onto the real form in your own words.

Start at Q1Email me the printable planner

The PIP2 questions in order

  1. Q1a Your conditions and when they started
  2. Q1b Medication, dose and side effects
  3. Q1c Treatments
  4. Q2 Health professionals
  5. Q3 Preparing food
  6. Q4 Eating and drinking
  7. Q5 Managing your treatments
  8. Q6 Washing and bathing
  9. Q7 Using the toilet and managing incontinence
  10. Q8 Dressing and undressing
  11. Q9 Talking, listening and understanding
  12. Q10 Reading
  13. Q11 Mixing with other people
  14. Q12 Managing money
  15. Q13 Planning and following a journey
  16. Q14 Moving around
  17. Q15 Additional information

How to use it

What you type stays in this browser only.
Section 1 · About your health condition or disability
Section 1 · About your health condition or disabilityPIP2 · Q1

Q1 Your conditions, medication and treatments

On the form: Q1a
Tell us in the space below: what health condition or disability do you have? The approximate start date.

By condition or disability, the form means physical, sight, hearing or speech difficulties, learning, developmental or behavioural difficulties or mental health conditions.

On the form: Q1b
Tell us about tablets or other medication you are taking or will be taking and the dosage. If you have side effects from taking your medication, please tell us what they are.

Side effects that limit what you can do (drowsiness, sickness, poor concentration) belong here and in the activities they affect.

On the form: Q1c
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).
Section 2 · About your health professionals
Section 2 · About your health professionalsPIP2 · Q2

Q2 Your health professionals

On the form: Q2
Please tell us below about any health professionals who treat or care for you most regularly and who are best placed to advise us on how your health condition or disability affects you. For example, a GP, hospital doctor, specialist nurse, community psychiatric nurse, occupational therapist, physiotherapist, social worker, counsellor or support worker.

The form has room for 3. The people who have seen you most recently often know your day best. If you need to add more, use Q15.

Health professional 1
Health professional 2
Health professional 3
Section 3 · Daily living activities
Section 3 · Daily living activitiesPIP2 · Q3

Q3 Preparing food

This means: Making a simple, one course meal for one from fresh ingredients: peeling and chopping, opening tins and cooking or heating food on a hob or in a microwave. Do consider if you can prepare food safely and without being supervised.

On the form: Q3a
Does your condition affect you preparing food, or prevent you from doing so?
Put a cross in one box on the form. For your plan:
You plan to cross No, and the form then says go to the next question. Before you do, check you can do all of this reliably: safely, to an acceptable standard, as often as you need to and in a reasonable time. If that is true on most days, No is the honest answer.
On the form: Q3b (the box you write in)
Tell us about the difficulties you have with preparing food and how you manage them.
For each difficulty, please tell us:
  • how often you have this difficulty: tell us about both good and bad days
  • what the difficulty is
  • why you have it, or how it relates to your condition
  • any aids or adaptations you use, or help you get from another person
  • any help you feel you need but do not get
Aids you use or need
Prompting, supervision and help
Can you do it reliably? Tick any that are true
Days it affects you in a typical week
Section 3 · Daily living activitiesPIP2 · Q4

Q4 Eating and drinking

This means: Remembering when to eat, cutting food into pieces, putting food and drink in your mouth and chewing and swallowing. Do consider if you need help cutting up food, getting it to your mouth or if someone needs to prompt, encourage or remind you to eat.

On the form: Q4a
Does your condition affect you eating and drinking?
Put a cross in one box on the form. For your plan:
You plan to cross No, and the form then says go to the next question. Before you do, check you can do all of this reliably: safely, to an acceptable standard, as often as you need to and in a reasonable time. If that is true on most days, No is the honest answer.
On the form: Q4b
Do you use a feeding tube or similar device to eat or drink?
On the form: Q4c (the box you write in)
Tell us about the difficulties you have with eating and drinking and how you manage them.
For each difficulty, please tell us:
  • how often you have this difficulty: tell us about both good and bad days
  • what the difficulty is
  • why you have it, or how it relates to your condition
  • any aids or adaptations you use, or help you get from another person
  • any help you feel you need but do not get
Aids you use or need
Prompting, supervision and help
Can you do it reliably? Tick any that are true
Days it affects you in a typical week
Section 3 · Daily living activitiesPIP2 · Q5

Q5 Managing your treatments

This means: Monitoring changes in your health (for example blood sugar, mental state or pain), taking medication in the right way at the right time and managing therapies at home recommended by a health professional. List the medicines themselves at Q1b. This question is about managing them, and about therapy at home.

On the form: Q5a
Does your condition affect you managing your treatments?
Put a cross in one box on the form. For your plan:
You plan to cross No, and the form then says go to the next question. Before you do, check you can do all of this reliably: safely, to an acceptable standard, as often as you need to and in a reasonable time. If that is true on most days, No is the honest answer.
On the form: Q5b (the box you write in)
Tell us about the difficulties you have with monitoring changes in your health condition or disability and taking medication, and how you manage them.
For each difficulty, please tell us:
  • how often you have this difficulty: tell us about both good and bad days
  • what the difficulty is
  • why you have it, or how it relates to your condition
  • any aids or adaptations you use, or help you get from another person
  • any help you feel you need but do not get
Aids you use or need
Prompting, supervision and help
Can you do it reliably? Tick any that are true
Days it affects you in a typical week
On the form: Q5c (a second box)
Tell us about any therapies you take at home that need the help of another person.
We want to know about:
  • what the therapy is
  • how often you receive the therapy
  • how long the therapy takes
  • the type of assistance you need from another person and for how long
  • any help you feel you need but do not get
Section 3 · Daily living activitiesPIP2 · Q6

Q6 Washing and bathing

This means: Washing your body, limbs, face, underarms and hair, using a normal bath or shower and getting in and out of it. Do consider if you can wash or bathe safely and without being supervised. And consider how much time it takes you and whether you do it too often or not often enough.

On the form: Q6a
Does your condition affect you washing and bathing?
Put a cross in one box on the form. For your plan:
You plan to cross No, and the form then says go to the next question. Before you do, check you can do all of this reliably: safely, to an acceptable standard, as often as you need to and in a reasonable time. If that is true on most days, No is the honest answer.
On the form: Q6b (the box you write in)
Tell us about the difficulties you have with washing and bathing and how you manage them.
For each difficulty, please tell us:
  • how often you have this difficulty: tell us about both good and bad days
  • what the difficulty is
  • why you have it, or how it relates to your condition
  • any aids or adaptations you use, or help you get from another person
  • any help you feel you need but do not get
Aids you use or need
Prompting, supervision and help
Can you do it reliably? Tick any that are true
Days it affects you in a typical week
Section 3 · Daily living activitiesPIP2 · Q7

Q7 Using the toilet and managing incontinence

This means: Getting on and off a normal toilet and cleaning yourself afterwards. It also means managing your bladder and bowel if you have difficulty controlling them, including a catheter or stoma bag. This does not mean physically getting to the bathroom.

On the form: Q7a
Does your condition affect you using the toilet or managing incontinence?
Put a cross in one box on the form. For your plan:
You plan to cross No, and the form then says go to the next question. Before you do, check you can do all of this reliably: safely, to an acceptable standard, as often as you need to and in a reasonable time. If that is true on most days, No is the honest answer.
On the form: Q7b (the box you write in)
Tell us about the difficulties you have using the toilet and how you manage them.
For each difficulty, please tell us:
  • how often you have this difficulty: tell us about both good and bad days
  • what the difficulty is
  • why you have it, or how it relates to your condition
  • any aids or adaptations you use, or help you get from another person
  • any help you feel you need but do not get
Aids you use or need
Prompting, supervision and help
Can you do it reliably? Tick any that are true
Days it affects you in a typical week
Section 3 · Daily living activitiesPIP2 · Q8

Q8 Dressing and undressing

This means: Putting on and taking off clothes (including shoes and socks), doing up zips or buttons and knowing when to put on or take off clothes. Do consider if it takes you too long to dress or undress.

On the form: Q8a
Does your condition affect you dressing or undressing?
Put a cross in one box on the form. For your plan:
You plan to cross No, and the form then says go to the next question. Before you do, check you can do all of this reliably: safely, to an acceptable standard, as often as you need to and in a reasonable time. If that is true on most days, No is the honest answer.
On the form: Q8b (the box you write in)
Tell us about the difficulties you have with dressing and undressing and how you manage them.
For each difficulty, please tell us:
  • how often you have this difficulty: tell us about both good and bad days
  • what the difficulty is
  • why you have it, or how it relates to your condition
  • any aids or adaptations you use, or help you get from another person
  • any help you feel you need but do not get
Aids you use or need
Prompting, supervision and help
Can you do it reliably? Tick any that are true
Days it affects you in a typical week
Section 3 · Daily living activitiesPIP2 · Q9

Q9 Talking, listening and understanding

This means: In your own language: speaking clearly to people, being understood by others and listening to and understanding what people say.

On the form: Q9a
Does your condition affect you talking, listening and understanding?
Put a cross in one box on the form. For your plan:
You plan to cross No, and the form then says go to the next question. Before you do, check you can do all of this reliably: safely, to an acceptable standard, as often as you need to and in a reasonable time. If that is true on most days, No is the honest answer.
On the form: Q9b (the box you write in)
Tell us about the difficulties you have with talking, listening and understanding and how you manage them.
For each difficulty, please tell us:
  • how often you have this difficulty: tell us about both good and bad days
  • what the difficulty is
  • why you have it, or how it relates to your condition
  • any aids or adaptations you use, or help you get from another person
  • any help you feel you need but do not get
Aids you use or need
Prompting, supervision and help
Can you do it reliably? Tick any that are true
Days it affects you in a typical week
Section 3 · Daily living activitiesPIP2 · Q10

Q10 Reading

This means: In your own language: reading written words and numbers indoors and outdoors and reading signs and symbols (for example a green exit sign). For this question, you must be able to see the information. Using braille to read is not counted as reading and you should give more detail about how your condition affects your ability to read.

On the form: Q10a
Does your condition affect your ability to read?
Put a cross in one box on the form. For your plan:
You plan to cross No, and the form then says go to the next question. Before you do, check you can do all of this reliably: safely, to an acceptable standard, as often as you need to and in a reasonable time. If that is true on most days, No is the honest answer.
On the form: Q10b (the box you write in)
Tell us about the difficulties you have with reading words or symbols and how you manage them.
For each difficulty, please tell us:
  • how often you have this difficulty: tell us about both good and bad days
  • what the difficulty is
  • why you have it, or how it relates to your condition
  • any aids or adaptations you use, or help you get from another person
  • any help you feel you need but do not get
Aids you use or need
Prompting, supervision and help
Can you do it reliably? Tick any that are true
Days it affects you in a typical week
Section 3 · Daily living activitiesPIP2 · Q11

Q11 Mixing with other people

This means: Meeting people face to face, understanding how they behave towards you (including body language), behaving appropriately and making new relationships, with people you know and people you do not.

On the form: Q11a
Does your condition affect you mixing with other people?
Put a cross in one box on the form. For your plan:
You plan to cross No, and the form then says go to the next question. Before you do, check you can do all of this reliably: safely, to an acceptable standard, as often as you need to and in a reasonable time. If that is true on most days, No is the honest answer.
On the form: Q11b (the box you write in)
Tell us about the difficulties you have with mixing with other people and how you manage them.
For each difficulty, please tell us:
  • how often you have this difficulty: tell us about both good and bad days
  • what the difficulty is
  • why you have it, or how it relates to your condition
  • any help you get from another person
  • any help you feel you need but do not get
  • whether severe anxiety or distress stops you from doing this
  • about any risk of harm to you and others
Help, and what stops you
Can you do it reliably? Tick any that are true
Days it affects you in a typical week
Section 3 · Daily living activitiesPIP2 · Q12

Q12 Managing money

This means: Understanding what things cost and how much change you should get, managing your own budgets, paying bills and planning future purchases. This does not mean taking a bill to the post box or being able to hold your change. This also does not mean being able to read a bill or physically open a letter.

On the form: Q12a
Does your condition affect you managing your money?
Put a cross in one box on the form. For your plan:
You plan to cross No, and the form then says go to the next question. Before you do, check you can do all of this reliably: safely, to an acceptable standard, as often as you need to and in a reasonable time. If that is true on most days, No is the honest answer.
On the form: Q12b (the box you write in)
Tell us about the difficulties you have with managing your money and how you manage them.
For each difficulty, please tell us:
  • how often you have this difficulty: tell us about both good and bad days
  • what the difficulty is
  • why you have it, or how it relates to your condition
  • any help you get from another person
  • any help you feel you need but do not get
Prompting, supervision and help
Can you do it reliably? Tick any that are true
Days it affects you in a typical week
Section 3 · Mobility activities
Section 3 · Mobility activitiesPIP2 · Q13

Q13 Planning and following a journey

This means: Leaving your home to go out, following a route you know well and working out and following a new route, for example when a road on your usual route is closed. This question is not about if you can physically move around.

On the form: Q13a
Does your condition affect you planning and following journeys?
Put a cross in one box on the form. For your plan:
You plan to cross No, and the form then says go to the next question. Before you do, check you can do all of this reliably: safely, to an acceptable standard, as often as you need to and in a reasonable time. If that is true on most days, No is the honest answer.
On the form: Q13b (the box you write in)
Tell us more about the difficulties you have with planning and following journeys and how you manage them.
For each difficulty, please tell us:
  • how often you have this difficulty: tell us about both good and bad days
  • what the difficulty is
  • why you have it, or how it relates to your condition
  • any aids you have, such as an assistance dog or long cane
  • any help you get from another person
  • if severe anxiety or distress stops you from leaving the home, following or completing a journey
  • any help you feel you need but do not get
Aids you use or need
Help, and what stops you
Can you do it reliably? Tick any that are true
Days it affects you in a typical week
Section 3 · Mobility activitiesPIP2 · Q14

Q14 Moving around

This means: How well you can walk without any specialist equipment or support from another person.

On the form: Q14a
Does your condition affect you moving around?
Put a cross in one box on the form. For your plan:
You plan to cross No, and the form then says go to the next question. Before you do, check you can do all of this reliably: safely, to an acceptable standard, as often as you need to and in a reasonable time. If that is true on most days, No is the honest answer.
On the form: Q14b
How far can you walk using any aids or appliances you need?

The form says: "To give you an idea of distance, 50 metres is about 5 buses parked end to end. Walking aids and appliances include walking sticks, walking frames, crutches, artificial limbs. A wheelchair or mobility scooter does not count as an aid or appliance for this question. If you use a wheelchair or mobility scooter, please answer this question by telling us how well you can stand and move without using it."

Work out your distance with your own steps

Buses are only a rough guide. Your own steps are better. Do this only on a typical day, if it is safe, with someone nearby if you might fall. Stop where you would normally have to stop: do not push through pain, breathlessness or dizziness to get a bigger number.

  1. Measure a short stretch with a tape measure, for example 5 metres along a hallway.
  2. Walk it at your normal pace with the aids you normally use. Count your steps.
  3. Another time, count the steps you manage before you have to stop.

The sum: steps before stopping × (measured distance ÷ your steps for it) = about ______ metres.

If it varies

Say which distance applies on how many days, for example "less than 20 metres on 4 or 5 days a week, up to 50 metres on the others", and why it changes. The DWP looks at what applies on more than half of the days (regulation 7, SI 2013/377).

Could you walk it reliably?

The distance that counts is the one you can walk safely, to an acceptable standard, repeatedly and within a reasonable time (regulation 4(2A), SI 2013/377). Ask yourself:

  • Safely: without falls, near misses or needing to grab hold of things.
  • Repeatedly: could you do it again later the same day, as often as you would need to?
  • In a reasonable time: no more than twice as long as someone without your condition would take.
  • To an acceptable standard: without severe pain, breathlessness or exhaustion stopping you.
On the form: Q14c (the box you write in)
Tell us more about the difficulties you have with moving around and how you manage them.
For each difficulty, please tell us:
  • how often you have this difficulty: tell us about both good and bad days
  • what the difficulty is
  • why you have it, or how it relates to your condition
  • any aids, appliances or devices you use to get around including wheelchairs or mobility scooters
  • any help you get from another person
  • any help you feel you need but do not get
Aids you use or need
Prompting, supervision and help
What makes you stop
Can you do it reliably? Tick any that are true
Days it affects you in a typical week
Additional informationPIP2 · Q15

Q15 Additional information

On the form: Q15
Is there anything else you would like to tell us about?

The form says: "Tell us anything else you think we should know that you have not already told us about how your health condition or disability affects you. Carers, friends or family who want to give us additional information can also do so here. You do not have to complete this part if you have covered everything in the form. If you are using this space to give us more detail on earlier questions, tell us which questions you are answering."

  • How your conditions affect each other, if you have more than one.
  • A fourth or fifth health professional, if Q2 ran out of room.
  • Evidence you are still waiting for, so the DWP knows it is coming.
Section 4 · What happens nextBefore you post it

Before you post your real form

Section 4 of the form asks for your preferred phone number, any times of day the DWP cannot call you and any help you or someone coming with you would need at an assessment, for example with stairs, travel, communication or accessible toilets.

Based on the final checklist and Section 4 of the example PIP2 on gov.uk. If you need more time, call the PIP enquiry line before the date on your letter (gov.uk).

See one of these boxes written for you, free

Tell us about your health and FillMyPIP will write one box of your PIP2 for you, free, before you pay anything, at www.fillmypip.co.uk.

Guidance only, not legal or medical advice. Not affiliated with the DWP. Karol Slusarczyk t/a Benefits Expert, ICO registered (ICO:00014179042).

Free printable PDFPIP2 planner
Email me the printable planner
The blank planner as a PDF, one question per page, plus a checklist for posting your form back. Only your email address is sent: nothing you type in the planner leaves this page.

We send the PDF and a few emails about filling in the form. Unsubscribe any time. Privacy

See one of these boxes written for you, free

Tell us about your health and we will write one box of your PIP2 for you, free, before you pay anything.

See one box written free →

Want every box done? The PIP2 form filler writes all 12 activities from your answers for £99.99, one-off.

Where the question wording comes from

The question lines and box headings on this page are taken word for word from the example PIP2 that the DWP publishes on gov.uk for reference (Example: PIP2 how your disability affects you, Crown copyright, Open Government Licence v3.0). The tick lists, the days grid and the distance helper are ours, to help you plan: the real form asks you to write each answer in a box.

The rules on reliability and "most days" come from the Social Security (Personal Independence Payment) Regulations 2013, regulation 4 and regulation 7. The return time and how the form arrives come from gov.uk/pip/how-to-claim. The DWP always makes the decision.

Questions

Is this the real PIP2 form?

No. It is a planner for your own notes and it cannot be sent to the DWP. Your PIP2 ("How your disability affects you") comes after you start your claim: by post, or as an emailed link to fill in online if you claimed by phone. gov.uk says to return it within 1 month, and the date is on your letter.

Can I download the PIP2 form as a PDF?

Not one you can send. gov.uk publishes an example of the PIP2 for reference only, and the form you fill in has to be the one the DWP sends you. You can print this planner or get it as a PDF by email, then copy your notes onto the real form.

What are the PIP2 questions in order?

Q1a your conditions and when they started, Q1b medication, Q1c treatments, Q2 your health professionals, Q3 to Q12 the ten daily living activities (preparing food, eating and drinking, managing treatments, washing and bathing, using the toilet, dressing, talking and listening, reading, mixing with other people and managing money), Q13 and Q14 the two mobility activities (planning journeys and moving around) and Q15 additional information.

How far is 20 metres for PIP?

The PIP2 says 50 metres is about 5 buses parked end to end, so 20 metres is about 2. A better guide is your own steps: count them over a distance you have measured, then count the steps you manage before you have to stop. The Q14 helper on this page does the sum. Do not rely on an average step length, because yours may be much shorter.

Does the planner save what I type?

Only in this browser, on this device. Nothing you type is sent to us or to anyone else, and the Clear button deletes it. On a shared or public computer, print your notes and press Clear before you leave.