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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.

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First published:
3 September 2020
Last updated:


HC1(SC)W Claim for help with health costs , file type: PDF, file size: 179 KB

179 KB
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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).