Application for VA healthcare
- Form name:Application for Health Benefits (VA Form 10-10EZ)
- 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 healthcare. You must be enrolled in VA healthcare 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 (VA Form 10-10EZR)
If you’re currently enrolled in VA healthcare, use VA Form 10-10EZR to update your personal (like your emergency contact), health insurance, financial, or military service history information.