Operation Telephone Please complete and submit the form below and we will be glad to place you or your family member on our “Operation Telephone” call list. Once the request is received, someone from our office will contact you by the next business day. After sign up, we ask that you call this office at (540) 635-4128 between the hours of 12:00 (noon) and 5:00 P.M., each day to advise our communications officer of your welfare status. If your call is not received by 5:00 P.M., we will call your home. If we are unable to make contact with you by phone, we will attempt your emergency contact listed on the form. If no contact is made, one of our deputies will come to your residence to check on you. We do ask for a key to be kept in safe place for deputy or EMS to locate if needed, or for one to be provided and we will keep in lock box, in the Communications Center. Please give us notice when you are planning to be away from home and cannot be reached. We will note when you are leaving and when you plan to return, so we know when to resume calls. This service can be discontinued at any point per your request. There is no charge for this service! Full Name(*) Please let us know your name. Phone Number(*) Invalid Input Address(*) Invalid Input Invalid Input Your Email Please let us know your email address. Date of Birth(*) Invalid Input Please list any medical condition we should be aware of: Invalid Input Your Doctor's Name(*) Invalid Input Your Doctor's Phone(*) Invalid Input Your Doctor's Address Invalid Input Contact Person (in case of emergency): Invalid Input Contact's Address Invalid Input Invalid Input Contact's Phone Invalid Input Is there any additional information you wish us to have or be aware of? Invalid Input If you have any questions or would like help completing this form, please contact our office at the listed number above and we will be happy to assist you! Submit Request
