Lackey Virtual Urgent Care Application

Book Your Telehealth Appointment Free of Charge!
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

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

Do you live in Virginia?*

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:*

Note: Lackey Virtual Urgent Care cannot provide prescriptions for controlled substances and behavioral health medications.

Primary Reason for Visit*

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

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Name*

First NameMiddle NameLast NameSuffix

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:*

We must have a photo ID (such as a license or passport) in order to schedule your appointment. You can either email or text a picture of your photo ID to medclinic@lackeyhealthcare.org or you can use this form's options below to take a picture of your photo ID or upload a file of it.

Please Select How You Will Send Us Your Photo ID:*

I will email or text a picture of my photo ID to medclinic@lackeyhealthcare.orgI will use one of the options below to take a picture of my photo ID or upload a file of it.

Press the gray button below to 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

CityState

Zip Code