Applications

Below are the forms used to apply for VA healthcare benefits. We recommend you use them as a reference while you gather the required information we’ll need when you meet with us. Please remember, we are here to help you and are more than happy to complete and submit these forms for you at an appointment. If you choose to complete and submit the information on your own, we ask that you stop in with copies of your applications so we can put it in your file. Then if issues or concerns arise, we will have the information to assist you.

Enrollment Application – VA Form 10-10EZ – This is the application for enrolling in VA healthcare. All information is based off the previous calendar year’s income and it must be exact. If it gets approved based on incorrect information, the VA may come back years down the road and charge you for services you received but weren’t eligible for.

‌Income Update Application – VA Form 10-10EZR – This is also referred to as a Means Test, and it’s used to update your income so the VA can determine which co-pays, if any, you are responsible for.

Hardship Waiver Application – VA Form 10-10HS – This form is used when a veteran is not qualified for healthcare but has had a hardship that caused a significant change to income, such as loss of job, costly health issues, etc. You also have to complete the VA form 10-10EZ when submitting this application.

Family Caregive Support Application – VA Form 10-10CG – This application is for the caregiver of a veteran who served on or after September 11, 2001 and is in need of continual caregiver support due to serious physical or mental disabilities that incurred in the line of duty.