Get Hc5(d)

The HC5(D) is a claim form designed to help users request a refund for NHS dental charges that they have paid. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete the HC5(D) form online

1. Press the ‘Get Form’ button to access the HC5(D) form online and open it in the editor.
2. Fill in the patient's details in Part 1. This includes the surname, title, forename, sex, date of birth, National Insurance number, address, postcode, and daytime contact telephone number. Ensure the contact number is that of the person signing the form.
3. In Part 2, provide details of the NHS dental charges paid. Enter the amount you wish to claim for NHS dental charges and ensure you attach original receipts. If the treatment is ongoing or paid in installments, indicate that the claim should be submitted after the treatment or payments are finished.
4. Specify the bank account details where you want the refund paid in the same section. Include the names of account holder(s), full bank name, sort code, and account number. If you do not have a bank account, tick the relevant box.
5. For Part 3, list the name, address, and telephone number of the dentist. Also provide the start and completion dates of the treatment.
6. In Part 4, indicate the patient’s income status at the time of payment of the NHS dental charges. Tick the appropriate box related to benefits or exemptions. Ensure to send the form to the correct address based on your selection.
7. Complete Part 5 by signing and dating the declaration. If you are signing for someone else, ensure that person has provided the necessary information, and you must sign accordingly.
8. Lastly, review your completed form for accuracy, then save your changes. You may choose to download, print, or share the form as needed before submission.

Start filling out the HC5(D) form online today to ensure you get your refund for NHS dental charges.