VA Form VA 10-10172

2025 Printable Template

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Form last updated: 03/2024. Please verify this is the current version before use.

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01

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02

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03

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How to fill out a VA 10-10172 online?

Follow these steps to complete your VA 10-10172 form online.

Step 01

Read the instructions for VA Form 10-10172 carefully.

Step 02

Provide your personal information accurately.

Step 03

Include specific details relevant to your request.

Step 04

Review the form for any errors before submission.

Step 05

Sign the form according to the guidelines.

Step 06

Submit the completed form to the appropriate VA office.

Department of Veterans Affairs

What is a VA 10-10172 used for?

VA Form 10-10172 is used by veterans to request and authorize the release of their medical records. This form facilitates the secure sharing of medical information with authorized parties, such as healthcare providers or representatives, for purposes like ongoing medical care or personal records management.

Who needs to fill out a VA 10-10172 form

Veterans or their representatives who need to authorize the release of medical records.

What is VA Form 10-10172?

It is a form used to request and authorize the release of medical records for veterans.

How do I submit VA Form 10-10172?

You can submit the form by mail or electronically through the HealthShare Referral Manager.

What should I do if I made a mistake on the form?

You should submit a corrected version of the form using the same submission method.

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