Lackey Virtual Urgent Care Application

Book Your Telehealth Appointment for $25
Questions?
Call: 757-369-2515

If you are experiencing any of the following life-threatening conditions, please call 911 immediately or visit the closest Emergency Department: Severe Pain | Possible Heart Condition | Serious Injury | Possible Poisoning | Altered Level of Consciousness | Trouble Breathing

Note: A translator is required for your Lackey Virtual Urgent Care visit if you need language support services.

Have you already been approved to be a Lackey Clinic Patient? *

What area do you live in? *

Please call our Main Office at 757-886-0608 to schedule an appointment. Have your Lackey Clinic Patient Card ready when you call. Thank you for being a member of the Lackey Clinic Family!

Unfortunately, you live outside of our service area, so you are not eligible for Lackey Virtual Urgent Care.

Please select one of our available telehealth appointments: *

Primary Reason for Visit *

Please describe the condition(s) you are experiencing: *

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Name *

First Name Last Name

Date of Birth *

You must be 18 years or older to qualify.

Gender *

Cell Phone Number *

Please enter a valid cell phone number.

Email Address

Choose which device you will use for your telehealth appointment: *

Take a picture of your photo ID OR upload your ID that contains your date of birth in it.

Take a picture of your photo ID

Or upload a file of your photo ID

Home Address (Note: You must be physically in Virginia at the time of the telehealth appointment in order to receive care from our VA licensed providers.) *

Street Address

Street Address Line 2

City State

Zip Code

You must submit a Photo ID to book an appointment.