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 Fill out the VA 10-10EZ form to enroll. Once you have completed, printed, and signed the VA form 10-10EZ you will need to fax it or mail it to you nearest VA Health Care System or you can enroll in person at any VA Medical Center or Clinic. Call 1-877-222-VETS for the nearest location.

https://www.1010ez.med.va.gov/sec/vha/1010ez/