Version NHS Help with Health Costs

LIS Form Ordering

Applications can only be made if you are a resident in England.

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Data Protection Act 1998. The Business Services Authority will disclose the information you have provided to an approved third party who will issue the appropriate application form. We will not disclose your information to other third parties nor transfer it outside of the European Economic Area. You may be contacted to discuss your application. Your personal data will be deleted from our systems and files 60 days after you have applied.