About VA Form 10-10EZ
- Related to: Health care
- Form last updated: January 21, 2020
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 PDFDownload VA Form 10-10EZ (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 (esp)
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.Download VA Form 10-10EZ (esp) (PDF)
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, or financial information.Download VA Form 10-10EZR (PDF)
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.