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Use this form to claim for help with health care costs if you have a low income.

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First published:
22 September 2020
Last updated:


Form HC1W: claim for help with health costs , file type: PDF, file size: 414 KB

414 KB
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The low income scheme helps people pay for health costs. If you are entitled to NHS treatment and meet certain conditions you may get help with the costs of:

  • NHS dental treatment
  • sight tests
  • glasses and contact lenses
  • necessary travel to and from hospital for NHS treatment under the care of a hospital consultant

If you would like to find out if the scheme can help you, try the NHS online checker.

You can request a printed copy of this form via email or by calling the publications order line on 0345 603 1108 (Rydym yn croesawu galwadau’n Gymraeg / We welcome calls in Welsh).