The Power of Community

Critical Life-Sustaining Medical Form

The City of Hartford Utilities maintains a “critical needs” customer list. During the summer months, there is an increased probability that utility system emergency conditions could develop. Hartford Utilities, together with our electric power supplier, WPPI Energy, continuously monitor all conditions. We will make every effort to avoid interrupting your service, however, emergency conditions beyond our control could result in your power being interrupted. If special circumstances exist in your home or business that make the loss of electricity or water critical, we will attempt to contact you prior to service being interrupted. We will do everything possible to protect all “critical needs” customers. 

Complete the Critical Life-Sustaining Medical Form (PDF) and returned only if special circumstances require you to have continuous electric or water service. Please complete the customer information and have your physician finish the bottom portion and return it directly to Hartford Utilities as soon as possible. The signed statement from your physician describing your life-sustaining need for electricity or water and the required equipment must be returned directly to us by the physician. The statement may be faxed to us at (262) 673-8301 or emailed to

Please note: This form only needs to be completed by individuals that have current conditions that make sustaining life impossible without electricity or water. There is no need to complete the form unless special conditions exist. If conditions arise in the future, a form may be obtained from the utility office. If you have questions or concerns, please call City of Hartford Utilities at (262) 673-8212.