Claim for Essential Medical Equipment Payment - Multiple Claim form (SA451)

Use this form if you’re claiming the Essential Medical Equipment Payment (EMEP) for more than one person living at the same address.

Download and complete the Essential Medical Equipment Payment - Multiple Claim form.

You can only claim for these items once:

  • essential medical equipment
  • medically required heating or cooling.

Each person living with you can’t claim EMEP for the same equipment or heating or cooling.

Your doctor will need to fill in the Medical practitioners confirmation section in the form before you submit it.

This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 13 December 2021