Use this form if you are entitled to claim for health costs and you live in a care home or recently left local authority care.
HC1(SC)W Claim for help with health costs , file type: PDF, file size: 179 KB
If you need a more accessible version of this document please email firstname.lastname@example.org. Please tell us the format you need. If you use assistive technology please tell us what this is.
Use this form if you need any of the following:
- NHS dental treatment
- sight tests, glasses or contact lenses
- travel to receive NHS treatment under the care of a consultant
- you live permanently in a care home and a local authority helps you with the cost of your accommodation or
- you are supported by a local authority because you have recently left local authority care
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).