Official VA Form

VA Form 10-10EZ

Instructions and Enrollment Application for Health Benefits

VA Form 10-10EZ — Instructions and Enrollment Application for Health Benefits is an official U.S. Department of Veterans Affairs form used for health care. The current version was last revised 2023-04-05. It is 6 pages long. Download the up-to-date PDF below — BaseNeed syncs form data directly from VA.gov so you always get the current edition.

Download the official PDF (VA.gov) →

Last revised: 2023-04-05
First issued: 2024-03-04
Pages: 6
Administered by: VHA

Health care

Frequently asked questions

What is VA Form 10-10EZ used for?

Instructions and Enrollment Application for Health Benefits. It is an official VA form in the Health care category, administered by VHA.

Where can I download the current VA Form 10-10EZ?

Download the official PDF from VA.gov here: https://www.va.gov/vaforms/medical/pdf/VA_Form_10-10EZ.pdf (last revised 2023-04-05).

How long is VA Form 10-10EZ?

VA Form 10-10EZ is 6 pages long, last revised 2023-04-05.

Always the current version — synced from VA.gov. BaseNeed is not affiliated with the U.S. Department of Veterans Affairs.

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Nearby form numbers

VA Form 10-10CG(T) — Application for the Program of Comprehensive Assistance for Family Caregivers – Tagalog
VA Form 10-10d — Application for CHAMPVA Benefits
VA Form 10-10EC — Application for Extended Care Services
VA Form 10-10EZR — INSTRUCCIONES PARA COMPLETAR EL FORMULARIO DE ACTUALIZACIÓN DE LOS BENEFICIOS MÉDICOS
VA Form 10-10HS — Request for Hardship Determination
VA Form 10-10M — Medical Certificate