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            "text": "3. Disability information",
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            "text": "Disability Type (please tick primary disability):"
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            "text": "ADD/ADHD □ Dyslexia/ Significant Literacy Difficulties □\nAutistic Spectrum Disorder (including Asperger’s Syndrome) □ Mental Health Condition (Include specific DSM-V and/or ICD-10 name and code below) □\nBlind/Vision Impaired □ Neurological Condition (including Brain Injury & Epilepsy) □\nDCD-Dyspraxia □ Physical Disability (those with significant mobility difficulties) □\nDeaf/Hard of Hearing □ Significant Ongoing Illness □\nDyscalculia/ Significant Numeracy Difficulties □ Speech and Language Communication Disorder □\nPlease state the specific name of the disability/condition (if relevant)\nNB: for Mental Health conditions, please provide the DSM-5 and/or ICD-10 name and codes):\nPlease state if there are any other disabilities/conditions:",
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                    "text": "Congenital",
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                    "text": "Acquired",
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            "text": "If acquired, is it:",
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                    "text": "Permanent",
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                    "text": "Temporary/Expected recovery",
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                    "text": "Fluctuating",
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            "text": "If temporary or fluctuating, please provide further details:"
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        {
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            "text": "The severity of the condition(s) is:"
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                    "text": "Mild",
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                    "text": "Moderate",
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                    "text": "Severe",
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            "text": "Please provide as much information as possible about the impact/severity of the condition on the applicant's daily life/functioning (i.e. social, emotional, physical impact)."
        },
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            },
            "text": "5/6",
            "attrs": {
                "block_label": "number"
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