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Use this form if you are entitled to help with dental charges and want to claim a refund.

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First published:
22 September 2020
Last updated:


HC5W(D) Claim form for a refund of NHS Dental Charges , file type: PDF, file size: 133 KB

133 KB
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Read about getting help with dental charges or use the online checker to see if you are entitled to help.

You can request a printed copy of this form via email or by calling the publications order line on 0345 603 1108.