Virginia online medication aide form 2026

1. Click ‘Get Form’ to open the Virginia online medication aide form in the editor.
2. Begin by filling out the Patient Information section. Enter your name, date of birth, age, phone number, and address. Ensure all fields marked with an asterisk (*) are completed.
3. Indicate your gender and select which vaccine(s) you would like to receive today. If applicable, provide your weight if it is less than 110 lbs.
4. Complete the Emergency Use Only section by providing details about your primary and alternate doctors, including their names and phone numbers.
5. Authorize the pharmacist to send copies of your vaccine documents to your primary care provider by selecting 'Yes' or 'No'.
6. Fill in your email address for communication purposes regarding special offers and information from Rite Aid.
7. Review all entered information for accuracy before submitting the form through our platform.

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