You can pick up an HC1 claim form from a Social Security office or NHS hospital. Your doctor, dentist or optician may have one too. You can also request a form by telephoning 0191 203 5555
 
 


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Orange fields are mandatory - Please complete all mandatory fields. (also marked with a * for older browsers)
*Forename
*Surname
*Title
   

*Address		 (house number and street name)
*Town
County
Postal Code


Tick this box if you wish to claim money back for health costs you have already paid.


 

  
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