Low Income Scheme refunds




To claim a refund of NHS charges, except prescription charges, fill in form HC5.  The form tells you what to do. 

If you need to pay for your treatment before applying to the NHS Low Income Scheme or seeking other exemption you may be able to claim a refund.

Obtaining form HC5

If you are resident in England and want to claim a refund of your health costs you can download and print off the relevant form:

  • NHS dental treatment HC5(D)
  • Sight test, glasses or contact lenses HC5(O)
  • Travel costs to receive necessary NHS treatment under the care of a consultant or through a referral by a doctor or dentist HC5(T)
  • NHS wigs or fabric supports HC5(W)

The HC5(W) form is only available to download. If you do not have access to a printer, you can contact us and we will print one and post it to you. You can also place an order for the other HC5 forms here, which will be posted to you. 

If you are resident in Scotland you can download and print off a Scottish HC5.  Please ensure you send all pages of the completed form when making your claim.  You can also get a copy of the Scottish HC5 form from your GP surgery or community pharmacy.

If you are resident in Wales you can get a copy of the appropriate Welsh HC5 form by calling 0845 6031108 (select the option for health publications).  You may also be able to get one from a Jobcentre Plus offices, NHS hospitals, doctors surgeries, dentists or opticians.