Serious Medical Condition Form

If you or someone in your household has a serious medical condition that requires the use of electrically-powered life support equipment, please print a request form and have it completed by your physician to be added to the Serious Medical Condition Certification list.  Download a copy of the certification form under "Serious Medical Condition Form". 



The form requires a physician's statement and signature. You must complete a form each year and Domninion must receive it within 30 days of the anniversary date of the last form you sent. If no form is received, it will be assumed that 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.



Note: Occasional power outages normally last from a few minutes to several hours. Be prepared with battery power or manual backup for your 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.