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Medical Equipment Notification Request

If you or someone in your household requires the use of electrically-powered life support equipment, use the request form below to be added to our medical conditions list. To download, you will need Acrobat Reader.

The form requires a physician's statement and signature. You must complete a form each year and we must receive it within 30 days of the anniversary date of the last form you sent. Otherwise, we will assume the condition no longer exists and the medical notation on your account will be removed.

We will make every effort to restore service as soon as possible--consistent with the total restoration effort.

  • Occasional power outages normally last from a few minutes to several hours. Be prepared with battery- or manually-powered medical equipment.
  • Longer outages, such as those resulting from hurricanes and ice storms, may last several days. Be prepared to relocate to a place where you can receive proper care until service is restored.