Our Compassionate Travel Grant is designed to provide travel funding, to support as many patients as possible. It is for those who are required to travel to access essential diagnostic tests, investigations, or treatment that are not reasonably available closer to home.
Please be advised that the amount currently available, is up to a maximum of £100.00 as a one-off payment.
Before completing this application, please ensure that you have explored all other available sources of travel support. Evidence may be requested.

This form must be completed by a member of the patient's care team.

Please allow a 10 working day processing time, and up to two weeks for payment, should the application be approved.

Applicant (Patient) Details

First Name

Last Name

Date of Birth

Home Address

Postcode

Contact telephone number

Email (if no email - write "no email")

Confirmed diagnosis

Reason for travel

Date of travel

Department & Hospital travelling to

Postcode

Mode of travel (e.g. car, train, etc)

Does the applicant require someone to travel with them?

YesNo

Known or estimated cost of travel (full amount per person)

Healthcare Professional Details

Please select here to state that you are a healthcare professional completing this form on behalf of a patient

I confirm the above statement is true

Please confirm that all other options for travel support have been explored e.g. hospital transport, etc

I confirm the above statement is true

HCP Full Name

Job Title

Practice / Hospital name and address

Postcode

HCP contact telephone number

HCP email address

Patient's bank details - Please note, without the patient's banking details we are unable to process the application.

Patient's Bank Name - TSB, Lloyds etc.

Sort Code

Account Number

Name as it appears on bank account

BEFORE submitting please ensure that all required fields have been completed - incomplete forms cannot be processed

Contact Information