Health careVA Form 10-10EZ
Application for Health Benefits
Enroll in VA health care to receive comprehensive medical services at VA facilities.
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Our on-site copy came from VA.gov on June 27, 2026. We check for updates monthly.
The VA updated this form on June 1, 2026. We’re double-checking that our on-site copy matches, so filling it out here is paused for the moment. The blank PDF and the VA.gov links above are always current.
Have these ready
This form asks for:
- Your name and date of birth
- Your Social Security number
- Contact details: your mailing address, phone number, and email
- Service details: branch, service dates, discharge type, and VA disability rating
BeneVets provides benefits navigation and education. For formal claims representation, connect with an accredited VSO representative.