Nicor gas medical certificate 2026

1. Click ‘Get Form’ to open the nicor gas medical certificate in the editor.
2. Begin by entering the NICOR GAS ACCOUNT number and PHONE NUMBER at the top of the form. This information is essential for identifying your account.
3. Fill in the PATIENT’S FULL NAME and DATE OF BIRTH. Ensure accuracy as this information is critical for verification purposes.
4. Next, provide the PARENT/ACCOUNT HOLDER’S NAME and PHONE NUMBER. This section helps establish contact for any follow-up regarding the certification.
5. Complete the STREET ADDRESS and CITY fields to specify where the patient resides, which is necessary for service considerations.
6. In the statement section, clearly explain how termination of natural gas will aggravate the patient's medical condition and confirm that they are a resident at the provided address. Include how long this has been a concern.
7. Finally, have a registered physician or local board of health complete their details in the Certifying Party section, including their name, phone number, facility address, signature, and license number.

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