Hc5 optical form online 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part 1, where you will enter the patient’s details. Fill in the surname, other names, title, date of birth, National Insurance number, address, postcode, and telephone number.
3. In Part 2, provide details of the optical charges paid. Indicate whether you are claiming for a sight test or glasses/contact lenses and include the relevant dates and amounts. Remember to attach original receipts and your optical prescription.
4. Part 3 requires you to input the name, address, and telephone number of the optical practice. Ensure this information is accurate for processing your claim.
5. In Part 4, tick the appropriate box regarding the patient’s income at the time of payment. Provide any necessary additional information as requested.
6. Finally, complete the declaration in Part 4 by signing and dating it. If filling out for someone else, ensure they sign where indicated.

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