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Department of Health

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HC5 refund claim forms

  • Last modified date:
    19 May 2009

New forms

New forms have been created for patients to use to claim refunds of NHS wigs or fabric supports, NHS dental costs, optical costs and travel costs incurred to receive NHS treatment. The forms are replacing the combined HC5 Refund claim form. The old forms will still be valid and supplies can be used up.

The HC5 (W) wigs and fabric supports form should be printed off from the link below by healthcare professionals and provided to patients from 1 April 2008.

The other forms listed below are available from the DH publications orderline 0845 610 1112 or NHS forms ordering website and email address below:

  • HC5 (T) travel form: this form is for the refund of costs incurred if you are referred for treatment under the care of a consultant, or referred by a doctor or dentist, and you travel to receive that treatment you can claim help with the cost of your travel on low income grounds. If you are referred by a doctor or dentist to the same premises but on a different day you can claim for that travel cost.
  • HC5 (O) optical charges claim form.
  • HC5 (D) for refunds of NHS dental charges.

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