Pseg sustaining life equipment 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with the CUSTOMER/PATIENT INFORMATION section. Fill in the required fields such as Customer of Record, Email, Address, PSE&G Account Number, Telephone Number, Patient’s Name, and DOB. Ensure accuracy for a smooth application process.
3. Proceed to the PHYSICIAN’S CERTIFICATION section. Enter the Physician’s Name, Practice/Specialty, Office Address, Phone, Fax, State License Number, and Last Medical Exam Date. This information is crucial for validation.
4. In the LIFE-SUSTAINING EQUIPMENT INFORMATION section, indicate if the patient uses life-sustaining equipment requiring electricity. Specify if an alternate power supply is available and provide details about Equipment Type and Model Number.
5. Complete any additional information regarding other medical conditions if applicable. This ensures that PSE&G can protect your account from service disconnection due to non-payment.
6. Finally, ensure that the form is signed by the physician before submitting it via fax or mail as indicated at the bottom of the form.

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