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About VA Form 10-10EZ (esp)

Form name: Instrucciones y Solicitud de Beneficios Medicos
Related to: Health care, Service member benefits
Form last updated: July 13, 2018

When to use this form

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.

Downloadable PDF

Download VA Form 10-10EZ (esp) (PDF)

Online tool

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

Go to the online tool
  • VA Form 10-10EZ

    Form name: Instructions and Enrollment Application for Health Benefits

    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).  

    Download VA Form 10-10EZ (PDF)
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