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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:

Documents

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

PDF
133 KB
If you need a more accessible version of this document please email digital@gov.wales. Please tell us the format you need. If you use assistive technology please tell us what this is.

Details

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.

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