Help with HCT 5 form

Hi

We have recently found out that we can claim back travel costs for taking Mum to hospital for her appointments and operation. I have the HCT 5 form but unsure how to fill it in and wondered if anyone here had any experience of it and could help?

I know the mileage to and from the appointments and found out the rate per mile that they will pay but nowhere on the form does it have anywhere to put this on. It just asks for what it cost you - easy if you used a bus/train/taxi etc.

Any help would be appreciated. 

Thanks xx