Patient Resources : Request an Appointment

Request an Appointment

Virginia Urology’s on-line appointment request.

This feature is for patients who would like to schedule a future appointment and is not intended for same or next day appointments. If you need an appointment today or tomorrow, please call 804-288-0339 and our staff will gladly assist you.

Please provide the following information to assist us in finding you the most convenient appointment. An appointment scheduler will return your request with a call or email between 8:00 am and 4:30 pm within the next two business days to confirm an appointment.

Please note, depending on the time the request is submitted, you may not receive a confirmation for up to 24 - 48 hours.

If this is a medical emergency, please go to the nearest hospital or call 911.

To make an appointment by phone please call: (804) 288-0339.

If your insurance requires a referral, please bring it on the day of your appointment.

Personal Information

Required fields are in red.

First Name

Middle Initial

Last Name

Date of Birth

Address 1

Address 2

City

State Zip Code

Work Phone

Home Phone

Primary Insurance Information

All questions in this section are optional.

Do you have insurance coverage?

Yes

Insurance Company

Insurance Type

Policy ID

Group Number

Primary Insurance’s Address
(This is on the back of the insurance card):

Street

City

State Zip Code

Appointment Information

Please note that the physician you select may not see patients at your preferred location.

Please select a physician:

Physican

Select a location:

Location

Have you seen any of our physicians before?

Yes

Primary Care Physician

Referring Physician

Reason for visit

Please enter the word you see in the image