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Enroll/Update for VA Medical Benefits
VA Form 10-10EZ - Application for Medical Benefits
The primary purpose of this form is to request enrollment in the VA Health Care System (Apply for Medical Benefits). Typically, Veterans who have NOT previously enrolled or applied for VA health care benefits should use this form. If you were previously enrolled in the VA Health Care System, and want to re-enroll, or update/change your information, use the VA Form 10-10EZR, Health Benefits Renewal Form.
Start Application for Enrollment Benefits
Before beginning the online submission process, we suggest viewing or printing the 10-10EZ form to assist in gathering all the information required to complete it.
If you have problems opening the form, try these solutions.
If you need assistance in completing the online application, view the Instructions for Completing the Application Online.
You can also submit VA Form 10-10EZ by mailing or faxing the completed (signed and dated) form to the VA Medical Center or Clinic of your choice.
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| Reviewed/Updated Date:
July 9, 2009
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