Get Va 10-10ez 2005

The VA 10-10EZ form is essential for veterans seeking health benefits from the Department of Veterans Affairs. This guide provides clear and supportive instructions to help you easily complete the application online.

Follow the steps to complete the VA 10-10EZ form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the veteran's name in the appropriate fields: last name, first name, and middle name. Make sure all names are spelled correctly.
3. Provide any other names you have used. This includes maiden names and aliases, as relevant.
4. Enter your mother's maiden name, as this can be used for identity verification.
5. Select your gender by checking the appropriate box.
6. Indicate if you identify as Spanish, Hispanic, or Latino.
7. Select your race. You may check more than one option if applicable.
8. Enter your Social Security number.
9. Input your date of birth in the specified format (mm/dd/yyyy).
10. Provide your claim number if you have one, otherwise leave it blank.
11. Fill in your place of birth, including city and state.
12. Complete your permanent address, including street, city, state, zip code, and any available contact information such as phone numbers and email.
13. Indicate the type of benefits you are applying for, checking all that apply.
14. Specify your preferred VA medical center or outpatient clinic.
15. Decide whether you want an appointment with a VA doctor as soon as available and indicate your choice.
16. Answer whether you have been seen at a VA healthcare facility and provide the location if applicable.
17. Indicate your current marital status by selecting the appropriate option.
18. Provide details for your next of kin, including name, address, relationship, and contact numbers.
19. Provide an emergency contact along with their details.
20. In the insurance information section, specify whether you are covered by health insurance and provide the relevant company information.
21. Complete sections related to employment information, military service, financial disclosure, and dependent information, ensuring accuracy throughout.
22. Review all sections for completeness and accuracy before proceeding.
23. Finally, save your changes, and you can download, print, or share the completed form.

Complete your VA 10-10EZ application online today to ensure you receive your health benefits.