VA Form 10-10EZ
- Form name:Instructions and Enrollment Application for Health Benefits
- Form revision date: February 2025
- Related to: Health care
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.
Related forms and instructions
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.