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Click ‘Get Form’ to open the HC5 form in the editor.
Begin by filling out Part 1 with the patient’s details, including surname, forename, date of birth, and contact information. Ensure accuracy as this information is crucial for processing your claim.
In Part 2, provide details of the NHS dental charges paid. Enter the amount you wish to claim and ensure you upload original receipts as required.
Complete Part 3 by entering your dentist's information and the dates when treatment started and was completed.
In Part 4, indicate your income status at the time of payment. Select the appropriate group and provide any necessary details.
Finally, sign and date the declaration in Part 5. If signing on behalf of someone else, ensure you follow the instructions provided.
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Send this form to: NHS Business Services Authority, Bridge House, 152 Pilgrim Street, Newcastle Upon Tyne, NE1 6SN.
How to fill in HC5 form?
Here are some tips for filling out the form: complete all relevant parts of the form. remember to check your bank details are correct in Part 2 of the form. make sure you sign and date the form. include an original receipt or prescription if relevant.
What is the HC5 form for glasses?
Use this form to claim back the cost of a sight test, glasses or contact lenses on low income grounds. For glasses and contact lenses, the maximum refund anyone can have is the voucher value that matches their prescription.
How do I claim a refund of NHS dental charges?
If you have paid an NHS dental charge you must receive a receipt, either an NHS receipt form FP64 or another receipt which shows the amount of the NHS charge and the date you paid it. To claim a refund you must complete this form and include all original receipts.
hc5 refund claim form
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