As a member, you can use the forms below to do things like get a new ID card, or change your Primary Care Provider (PCP). You can also call Member Services for help.

Change Your Address

Use this form to let Virginia Premier know when you’ve got a new address.

Member Change of Address Form (pdf)

Give Virginia Premier Permission to Speak

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.

Permission to Speak With Form (pdf)

Request ID Card

Use this form if you would need a new ID card.

Member ID Request Form (pdf)

Request a PCP Change

Complete this form to change your Primary Care Physician (PCP). Use our provider directory to choose a doctor and find their address.

PCP Change Request Form (pdf)

Substance Use Disorder Member Release of Confidential Information Consent Form

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.

Substance Use Disorder Member Release of Confidential Information Consent Form (pdf)