Rush Notary

Bruceville-Eddy, TX · McLennan County

No notary required

BE-WELL Program Request Form

Bruceville-Eddy residents use this form to request BE-WELL phone calls or update police department records with current information for emergencies.

What this form is

The Bruceville-Eddy Police Department’s BE-WELL Program is for residents within city limits who live alone, are seniors, or cannot regularly contact friends or family. The form collects contact, health-related, household, and emergency contact information, and lets residents specify how often they would like a phone call. It can also be used to update the department’s records for an emergency.

Who needs it

Bruceville-Eddy residents who live alone, are seniors, or cannot regularly contact friends or family can use this form to sign up or update their information.

How to submit it

Drop off the completed form at the Bruceville-Eddy Police Department or email it to [email protected]. To sign up by phone, call 254-859-5072.

About notarization

This document is signed without a notary; it lists no notarized or sworn attachment, so the signer just signs and dates it.

How to submit this form

  1. 1

    Download The Form

    Download the BE-WELL Program Request Form PDF.

  2. 2

    Complete The Form

    Fill in your contact, household, health-related, and emergency contact information, and specify your preferred call time and frequency.

  3. 3

    Gather Attachments

    The form does not list any required attachments.

  4. 4

    Submit To The City

    Drop off the form at the Bruceville-Eddy Police Department or email it to [email protected].

Frequently asked questions

Who can use the BE-WELL Program Request Form?
The program is for people who live within Bruceville-Eddy city limits, including residents who live alone, are seniors, or cannot regularly contact friends or family.
How do I submit the BE-WELL Program Request Form?
Drop it off at the Bruceville-Eddy Police Department or email it to [email protected]. To sign up by phone, call 254-859-5072.
What information does the form ask for?
It asks for contact and household details, information about impairments and medical history, emergency contact information, and preferred call time and frequency.
Do I need a notary for the BE-WELL Program Request Form?
No. This document is signed without a notary, and it lists no notarized or sworn attachment; the signer just signs and dates it.

Need something notarized?

This BE-WELL Program Request Form doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.