Acceda al sitio web de VA a y seleccione Contáctese con VA (” Contact the VA”). ¿Para qué sirve el Formulario VA EZ? AFECCIÓN. Fill va form 10 10ez va instantly, download blank or editable online. Sign, fax and printable from PC, iPad, tablet or mobile. No software. Try Now!. VA Form EZ – Application for Medical Benefits (Enroll). The primary purpose of this form is to request enrollment in the VA Health Care.

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We will begin processing the application upon receipt of the signed form.

The forms may not function correctly. To navigate this form, use the buttons provided on each page. If a new window does not appear, please check for a pop-up blocker. I have read this page and want to go to the Online Submission Form.

VA Form 10-10EZ – Application for Medical Benefits (Enroll)

Typically, veterans who have NOT previously enrolled or applied for VA health care benefits should use this form. If you the applicant are unable to sign the form, two people known to the applicant may witness the applicant making 101ez “X” on the form.

This will result in a delay in processing the application.


Click here to obtain a free copy of the Adobe Acrobat Reader software. If you stay on a single page for more than 20 minutes, a window will be displayed asking if you want to continue or close the online form.

Because of the sensitive nature of the information requested, the information is not saved in your computer or on our web server. You will be provided an opportunity to review and change your information prior to submission.

VA Health Benefits Application Form (EZ) – VFW Post

Click this link to run a Printing Test to ensure that you will be able to print your completed form. Click the “Continue” button promptly to avoid closing your form and erasing the information you have entered. If your browser does not have scripting enabled, or it does not support it. Instructions for 1010dz VA Form EZ On-Line Before beginning the online submission process, we suggest viewing or printing the EZ to foem you in gathering all the information required to complete it.

Do not use the browser ” Back ” and ” Forward ” buttons.

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You must have the latest version of Adobe Acrobat Reader on your computer to save or print the forms. This is a fotm form in that it will route you around sections of the form you do not have to complete which is based on the information you enter.


Before beginning the online submission process, we 10100ez viewing or printing the EZ to assist you in gathering all the information required to complete it.

If you have delegated someone else to sign the form, we must receive a copy of the Power of Attorney. If you have a pop-up blocker on your computer, you 1010wz adjust it to allow a pop-up from this site or disable it while completing this form.

If you for, not see the words “Print 1010z successful”you should check to make sure that Acrobat Reader has been installed. You the applicant must sign and date the printed copy and mail or fax it to the selected VA Facility. Enter your search text Button to start search. Therefore, the form must be completed in a single session. The witnesses must also sign the form and print their names. Additionally, the online form limits the amount of time your browser can remain idle.

If the form is not signed and dated, VA will return it to the applicant to complete.