Dominion Energy Medical Form - Helping to keep you safe in the event of an outage. Web the customer, the person with the serious medical condition, and a physician must complete a serious medical condition certification form and send it to the utility. Please email the complete form to or mail. Web if you or someone in your household have a serious medical need for electricity (such as needing electricity for a ventilator, continuous oxygen, feeding tube, etc.), you. Web download a copy of the certification form under s erious medical condition form . You must complete a form. Web this form was developed pursuant to: The form requires a physician's statement and signature.
The form requires a physician's statement and signature. Helping to keep you safe in the event of an outage. Web download a copy of the certification form under s erious medical condition form . Web this form was developed pursuant to: Please email the complete form to or mail. You must complete a form. Web if you or someone in your household have a serious medical need for electricity (such as needing electricity for a ventilator, continuous oxygen, feeding tube, etc.), you. Web the customer, the person with the serious medical condition, and a physician must complete a serious medical condition certification form and send it to the utility.