The following information about this VA form comes from the VA forms database, and any changes are updated here nightly. Contact the form administration for further information.
Link to form
https://www.va.gov/vaforms/medical/pdf/VA Form 10-10EZ.pdf
Form number
10-10EZ
Row ID
5403
Form title
Instructions For Completing Enrollment Application For Health Benefits
Issue date
Revision date
Form administration
VHA
Number of pages
5
Deleted
False
Form name
Instructions and Enrollment Application for Health Benefits
Form Language
English
Related to
Benefits
VA health care
When to use

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).  

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