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
Download VA Form 10-10EZ (PDF)
Online tool
You can apply online instead of filling out and sending us the paper form.
Related forms and instructions
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VA Form 10-10EZ
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.
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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.
Helpful links related to VA Form 10-10EZ
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Eligibility for VA health care
Find out if you’re eligible for VA health care.
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Refill and track your VA prescriptions
Order a prescription refill and track your shipment online.
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Schedule and manage health appointments
Find out how to schedule an appointment by phone, online, or through Secure Messaging.
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Order hearing aid batteries and accessories
Order items for VA-issued hearing aids online for home delivery.
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Order prosthetic socks
Find out how to order prosthetic socks for Veterans with amputations.
