Get Temple Va Adaptive Equipment Request Form

Use the Health Benefits Update Form (VA Form 10-10EZR) to update your personal, financial, and insurance information after you're enrolled in VA health care.

Use VA Form 21-4502 if you're a Veteran with a disability and you want to apply for compensation for a vehicle that meets your needs. This may include a specially equipped vehicle for you to drive or adaptive equipment to help you get in and out of your vehicle.

Durable Medical Equipment (DME) Requirements To request routine DME, prosthetics or orthotics for a Veteran, complete VA Form 10-10172, Community Care Provider—Request for Service, and return it to your local VA facility's community care office. Page 2 of the form is dedicated to these specific requests.

PERSONALLY-OWNED PROPERTY. VA Form 2235 will be used for personally- owned property placed in official/unofficial use. Employees are required to obtain approval from their supervisors and advising the facility AO prior to bringing a piece of personally-owned property to a VA facility or placing it in use.

Use VA Form 21-526EZ when you want to apply for VA disability compensation (pay) and related benefits.

If you can't, or don't want to file online, you can file a claim for additional disability compensation by mail using these forms: For a spouse or a child under 18 years of age, you'll need to fill out an Application Request to Add and/or Remove Dependents (VA Form 21-686c).

For the one-time payment to help you buy a specially equipped vehicle. You'll need to fill out an Application for Automobile or Other Conveyance and Adaptive Equipment (VA Form 21-4502). We'll pay the vehicle's seller directly.

What form is used when turning in excess furniture or equipment? Excess is processed via VA Form 2237 (Request, Turn-In and Receipt for Property or Services) which can be found on VA Forms.