Request For Services Form

At Liberty, you're not just a patient, you're a Member.

Liberty Medical Center of Texas (LMC) is proud to offer HIPAA-compliant tele-health services to qualifying veterans.
To be approved, please complete the online form and submit a copy of your military service records.
Remember, we do NOT consider your discharge status OR whether you currently utilize VA benefits.

* Indicates required field

Full Name *

First

Last

Email *

Phone Number *

How can we help? *

Accepted documents:
DD214 (Member-4 or Service-2) or NGB22

Upload File *

Max file size: 20MB

I would like to receive updates from LMC *

Yes No

Submit

You are welcome to call us at (214) 531-0541 regarding our services. Just leave a message and we'll get back to you within 24 hours.