Fill Out VA Form 10-10EZ Online
Application for Health Benefits
U.S. Department of Veterans Affairs
Applies for enrollment in VA health care benefits.
Reviewed July 2026
How it works
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Open the form. The official PDF loads straight into the editor, no download needed first.
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Fill it out in the editor. Click anywhere to type, add checkmarks and place your signature.
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Download your PDF. Save the completed form, ready to print or submit.
VA Form 10-10EZ, the Application for Health Benefits, is the form veterans use to enroll in the VA health care system. Enrollment is what gives you access to care at VA medical centers and clinics, and it is also required before the VA will cover treatment from approved community providers.
You can open the 10-10EZ in the Universal PDF editor, type your answers directly into the form, and download the finished PDF when you are done. That gives you a clean, legible application you can print and mail or bring to a VA facility.
What is VA Form 10-10EZ used for
The 10-10EZ is the entry point to VA health care. The VA uses the information on the form to confirm your veteran status, assign you to a priority group, and determine whether you will owe copays for certain types of care.
The form collects four broad categories of information:
- Personal identification, including your Social Security number and contact details
- Military service history, such as branch, service dates, and discharge status
- Current health insurance coverage, including Medicare and private plans
- Optional financial information used to determine copay responsibility and priority group placement
Who files VA Form 10-10EZ
Veterans who want to enroll in VA health care for the first time file the 10-10EZ. Eligibility generally depends on your service history and discharge status, and some veterans qualify for enhanced eligibility based on factors such as service-connected disabilities, exposure history, or income.
If you are already enrolled and only need to update your personal, insurance, or financial information, the VA provides a separate update form, VA Form 10-10EZR, for that purpose.
How to fill out VA Form 10-10EZ
Work through the form section by section and have your documents nearby before you start:
- Personal information: legal name, Social Security number, date of birth, address, and phone number
- Military service: branch, entry and discharge dates, and discharge type; your DD Form 214 has most of these details
- Insurance: list all current health coverage, including Medicare, Medicaid, and employer or private plans
- Financial disclosure: this section is optional, but skipping it can affect your priority group and copay determination if you do not have another basis for enhanced eligibility
- Signature and date: review everything, then sign and date the form before submitting it
Where to send it
The VA accepts health care applications online through VA.gov, by mail, and in person at VA medical centers and clinics. The current form's instruction pages list the mailing address to use, so check the copy you download for the up-to-date submission details.
If you want help with the application, an accredited veterans service organization (VSO) representative can walk you through it at no obligation to enroll.
Frequently asked questions
The 10-10EZ is the initial application to enroll in VA health care. The 10-10EZR is the update form used by veterans who are already enrolled and need to report changes to personal, insurance, or financial information.
The financial disclosure section is optional. However, if you do not qualify for enhanced eligibility on another basis, declining to provide it can affect your priority group assignment and whether you owe copays.
It is not always required, but it is the easiest way to document your service dates and discharge status, and the VA may request it. If you cannot find yours, you can request a copy from the National Archives using Standard Form 180.
Yes. Anyone can help you fill in the form, but the veteran applying must sign it. An accredited VSO representative can also assist with the application at no obligation.
Yes. Open the PDF in the Universal PDF editor, type your answers into each field, then download the completed file to print and sign before submitting it to the VA.
Related forms
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