About VA Form 10-10EZ (esp)
- Related to: Health care
- Form last updated: July 21, 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 PDFDownload VA Form 10-10EZ (esp) (PDF)
You can apply online instead of filling out and sending us the paper form.Go to the online tool
Related forms and instructions
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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