10-10EZ
Instructions and Enrollment Application for Health Benefits
- Agency
- VA
- Revision
- 2025-02-01
- Fillable fields
- 122
- Pages
- 6
Form 10-10EZ: 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).
How to fill out Form 10-10EZ online
- 1
Open the form
Press Fill 10-10EZ online. The official form opens in your browser, ready to type into.
- 2
Fill in the fields
Click a field and type. Move through the form at your own pace, nothing is sent anywhere until you choose.
- 3
Download or print
Save the filled form as a PDF or print it. You do not need an account to download it.
Why fill Form 10-10EZ on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
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- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
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