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Form 3064 Application (English) for Health Care Assistance
(click above for the pdf document to print out on paper and write in)
(click above for fillable and printable pdf)
Form 3064 Application (Spanish) for Health Care Assistance
Form 3076 (English Version) Case Record Information Release
Form 3076 (Spanish Version) Case Record Information Release
Program Application Update
Please click here to view Additional Benefits and Services for Eligible Veterans.
* 101 West Main St. Mail Unit 14 Room B104 *
* Fredericksburg, TX 78624-3700 *
* Phone 830-990-7567 * Fax 830-992-2621 *
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