Apply for a refund

Download the form you need for the type of refund you're applying for.

To apply by post, print and complete the refund application form. The form tells you where to send it.

You cannot apply by email for refunds of travel costs, wigs or fabric supports.

Dental refunds

Dental refund application form HC5(D) (PDF: 723KB)​​

Email your completed form to [email protected]

Eye care refunds

Optical refund application form HC5(O) (PDF: 304KB)

Email your completed form to [email protected]

Travel refunds

Travel refund application form: HC5(T) (PDF: 113KB)Post your completed form to us. The form tells you where to send it.

Wigs or fabric support refunds

Wigs or fabric supports refund application form: HC5(W) (PDF: 88KB)

Post your completed form to us. The form tells you where to send it.

If you cannot download the forms

You can order a form online or telephone: 0300 330 1343 and we'll post it to you.

Find out about call charges

Download and print

HC5 - Scotland refund form (PDF: 80KB)Complete the form and post it to us. The form tells you where to send it.

You can also get an HC5 from your GP practice or pharmacy.

Download leaflets and forms from help with health costs (on GOV.WALES).

You can also call 0345 603 1108 and select the option for health publications to get a copy sent to you.

You might be able to get an HC5 from Jobcentres, NHS hospitals, GP practices, dentists or opticians.