Life Support Phone Number Update Form

We are required by the New York State Public Service Commission to contact our Life Support customers during outage events. It is crucial that while you are part of the Life Support Program we maintain valid contact phone numbers for you.

If we are unable to reach you by phone, we are required to send an emergency field technician to your home to check on the Life Support Patient's safety and make contact during an outage.

* indicates required fields

Is your account currently enrolled in the Life Support Program?

YesNo

Customer Details

Customer Name

Account Number (Please enter a valid value in the format of 12345-12345)

Street Address

City

State

Zip Code

Patient Name

Email Address

Phone Numbers

Disclaimer: By providing us with your phone number you agree to receive auto-dialed outage phone calls.

Primary Phone Number (Please enter a valid value in the format of 999-999-9999)

Primary Phone Type

Alternate Phone Number (Please enter a valid value in the format of 999-999-9999)

Alternate Phone Type

Emergency Contact

Emergency Contact phone numbers will only be used for Life Support related phone calls.

Emergency Contact Name #1

Emergency Contact Number #1 (Please enter a valid value in the format of 999-999-9999)

Emergency Contact #1 Phone Type

Emergency Contact Name #2

Emergency Contact Number #2 (Please enter a valid value in the format of 999-999-9999)

Emergency Contact #2 Phone Type

Click to certify information is true:

Yes, I certify that the information above is true and correct to the best of my knowledge.

If you are not currently enrolled in the Life Support Program or want to learn more about our protection programs, please visit our Special Protections page.

Select Your Region

Massachusetts

New York

Life Support Phone Number Update Form

Customer Details

Phone Numbers

Emergency Contact