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About VA Form 10-10EZ

Form name: Instructions and Enrollment Application for Health Benefits
Related to: Health care
Form revision date: April 2023

When to use this form

Use VA Form 10-10EZ if you’re a Veteran and want to apply for VA health care. You must be enrolled in VA health care to get care at VA health facilities or to have us cover your care at a community care provider (an approved non-VA provider).  

Downloadable PDF

Online tool

You can apply online instead of filling out and sending us the paper form.

  • VA Form 10-10EZS

    Form name: Instrucciones y Solicitud de Beneficios Medicos

    Para que los Veteranos soliciten su afiliación al sistema de atención médica de VA. la información proporcionada en este formulario será utilizada por VA para determinar si usted reúne los requisitos para recibir beneficios médicos.

  • VA Form 10-10EZR

    Form name: Health Benefits Update Form

    Use VA Form 10-10EZR if you already receive VA health care benefits, and you need to update your personal, insurance, financial, or military service history information.

Helpful links related to VA Form 10-10EZ

  • Find out if you’re eligible for VA health care.

  • Order a prescription refill and track your shipment online.

  • Find out how to schedule an appointment by phone, online, or through Secure Messaging.

  • Order items for VA-issued hearing aids online for home delivery.

  • Find out how to order prosthetic socks for Veterans with amputations.

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