Use this form if you are entitled to claim a refund for travel costs for NHS treatment under the care of a consultant.
Documents
Claim form for a refund of travel costs to receive NHS treatment: form HC5W (T) , file type: PDF, file size: 80 KB
PDF
80 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
If you are on a low income and you need to travel to a NHS treatment under the care of a consultant, you can claim help with the cost of your travel.
If you need help with travel costs and you are aged 16 or over, please complete this form. If you are under 16, your parent(s) should fill in this form, as it is their income that counts.
You may also have to submit an HC1W claim form.
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).