WELLNESS CHECK REGISTRATION – City of Heath, TX

REGISTRATION

If you have a loved one who is vulnerable during emergency situations, please register them here for Wellness Checks by our Department of Public Safety. You may also request a lockbox be placed on their door and provide the key to DPS officers for access during an emergency incident. Register here:

YOUR INFORMATION

Complete this section with your contact information

YOUR NAME *

First

Last

YOUR EMAIL *

CELL PHONE *

HOME PHONE *

WELLNESS CHECK RECIPIENT INFORMATION

Complete this section with contact information for the person you wish to receive a wellness check.

RECIPIENT NAME *

First

Last

ADDRESS *

Address Line 1

City

State

Zip Code

RECIPIENT CELL PHONE *

RECIPIENT HOME PHONE *

Notes about this person, including any special health conditions or concerns