Pge medical baseline form 2026

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The document is a Medical Baseline Allowance Self-Certification Request Form from Pacific Gas and Electric Company (PG&E). It outlines the process for customers to self-certify their eligibility for a medical baseline allowance, which provides additional gas and electricity based on medical needs. The form requires customer and resident information, details about the medical condition, and preferences for outage notifications. It specifies the frequency of required certifications based on whether the medical condition is permanent or not.

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Click ‘Get Form’ to open the pge medical baseline form in the editor.
Begin with Step 1, where you will enter your account and customer information. Fill in your PG&E customer account number, customer name, service address, and contact details. Ensure all information is accurate for a smooth process.
Proceed to Step 2 if applicable, where you provide details for customers billed by someone other than PG&E. Include the name of the mobile home or apartment complex and its address.
In Step 3, select your preferred method of contact for planned or unplanned outages. You can choose up to two methods and provide relevant contact information next to your selections.
Finally, in Step 4, sign and date the form to certify that all provided information is correct. This step is crucial as it confirms your eligibility for the Medical Baseline Allowance.

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