Forms

Use this form to let Virginia Premier know when you have a new address.

Download the Member Change of Address Form >

Use this form if you would like to give Virginia Premier permission to speak with someone else (e.g., a family member) about your health information.

Download the Permission to Speak With Form >

Complete this form to request a new Virginia Premier member ID card.
Download the Member ID Card Request Form >

Please note that you can also request an ID card online in the Virginia Premier Member Portal.

Use this form if you would like to give Virginia Premier permission to disclose information to someone else (e.g., a family member or doctor) about your treatment for substance use disorder. Download the Substance Use Disorder Member Release of Confidential Information Consent Form >