Medical Emergency List Form

NAED maintains a Medical Emergency List of customers who depend on electrically powered, life sustaining medical equipment in their homes. In the event of a power outage, restoring electricity to these homes is a priority.

Fill out and submit the form below if you, a member or your household or a tenant is dependent on such medical equipment.

Household Information

A member of our household depends on electrically powered life-sustaining medical equipment. Please add us to NAED's Medical Emergency List.

Please remove the name below from the list. Life-sustaining medical equipment is no longer needed at this address.

Date

Name

Address

Phone number

Account Number

Type of life-sustaining equipment

Do you have a battery backup?

Yes

Do you have a backup generator?

Yes

Other comments:

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