MEDICAL PRIORITY SNOW REMOVAL REQUEST

FOR ALL MEDICAL EMERGENCIES CONTACT 911 IMMEDIATELY

This form should be filled out for chemotherapy or dialysis only.

Each winter, the Bella Vista Village Maintenance and Construction Division compiles a list of villagers who have priority medical conditions of chemotherapy or dialysis. Questions or concerns regarding oxygen or other medical conditions not listed should be directed to the Bella Vista police and fire departments, at (479) 855-3771.

Please fill out the accompanying form and return it to Bella Vista Village Maintenance and Construction Division, 51 Huntley Lane, Bella Vista, AR, 72715.

Note:  These forms MUST be completed each year.  

Name: _________________________________________

Address: _______________________________________

Phone: _________________________________________

Doctor’s Name: __________________________________

Doctor’s Phone Number: ___________________________

Medical Problem: _________________________________

Circle Appropriate Day (s):  M     T     W      Th     F     Sat     Sun

Appointment Time: _______________________________ 

Please fill out and return to:
Bella Vista Village Maintenance and Construction Division
(Formerly the Public Works Division)
51 Huntley Lane
Bella Vista, AR 72715
855-5060