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2. Life-Sustaining Equipment
   If you rely on electrically operated life-sustaining medical devices, and you may be in immediate danger if your electric service is interrupted, please review the information below and, if applicable, complete and return it to:
   Wellesley Municipal Light Plant
   Attn: Brenda Sullivan, Customer Service Department
   4 Municipal Way
   Wellesley, MA 02481
   
   While we inform customers about planned power outages and work hard to restore service as quickly as possible during unplanned outages, restoration does take time. We attempt to contact our customers on life-sustaining equipment before a planned outage. We also regularly review equipment requirements to stay up-to-date on our customers' needs. Should you have any questions please call Brenda Sullivan at the WMLP at 781-235-7600.
4. Account Number
5. First Name
6. Last Name
8. Address
10. Telephone Number
11. Email Address
13. The following life-sustaining equipment is in my home

    1. Heart Rate Monitor
    2. PD APNEA Monitor
    3. Diaphragm Stimulator
    4. Oxygen Concentrator
    5. Medical Pump
    6. Press Respirator

    1. Rocking Bed
    2. Electrically Operated Respirator
    3. Suction Machine (Pump)
    4. Hemodialysis Equipment
    5. Intermittent Positive Pressure Respirator
    6. CPM Drum Ventilator
15. Please list any other type of life-sustaining equipment or medical condition.
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

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