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Medical Condition And Equipment Form

Lineman & CloudsIf you have a medical condition that requires you to use medical equipment that relies on electricity, please print this form and have it signed by your doctor.  This will notify us that there are people living in your home who need restoration sooner.  We will make every effort to respond to your needs. However, we can not guarantee that we will restore electricity in a manner that would not threaten your dependence on medical equipment or would accommodate your medical condition. Section 1 is for Haywood EMC account information and Section 2 must be completed by your physician and returned to our office.

Medical Condition Form

Medical Condition Form.pdf
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Waynesville Physical Address

376 Grindstone Road
Waynesville, NC 28785
(828) 452-2281 or (800) 951-6088
(828) 926-4290 Fax

Lake Toxaway Physical Address

298 Blue Ridge Road
Lake Toxaway, NC 28747
(828) 966-4215
(828) 883-3874 Fax

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©2022 Haywood EMC. All Rights Reserved.

  • About Us
    • About Touchstone Energy
    • Board of Directors
    • Management Team
    • Employment
    • Cooperative Principles
      • Cooperative Difference Video
    • Service Territory Map
    • Together We Save
    • News Posts
  • Member Services
    • Application for Electric Service
    • Capital Credits
      • Frequently Asked Questions
      • Estate Retirements
      • Outstanding Capital Credits
    • Project HEMC
    • Service Rules & Regulations
    • Staking Department
    • Co-op Connections
    • Rate Schedules
      • EV Rates
      • Time Of Day Rates
    • Safety
      • Storm Preparedness
      • Safety Quiz
    • Billing Information
      • Easy Ways to Pay
      • How To Read Your Bill
      • Delinquent Bill Timeline
    • Forms
      • Service Order Form
      • Medical Condition And Equipment Form
    • HOPE Program
    • Smart Meter Energy Usage Data Privacy/Security Advisory
    • Text Outage Alerts
    • Title VI Statement of Non-discrimination
    • Tree Trimming
  • Products
    • Generlink
    • HomeServe Protection Plans
    • Surge Protection Program
    • Generators
      • Generator Loan
      • Generator Service Agreement
    • Heat Pumps
      • Heat Pump/Weatherization Loan
    • Security Lighting
  • Your Community
    • Bright Ideas Grants
    • The Haywood EMC Podcast
    • Carolina Country Magazine
    • TSE Sports Camp Scholarship
    • News
    • TSE Scholarship
    • Youth Tour Application
  • Energy Efficiency
    • Electric Vehicles
    • Whole House Energy Audit
    • CFL Disposal
    • NC GreenPower
    • Together We Save
    • Home Energy Adventure
    • Energy Star Home Advisor
  • Renewable Energy
    • Renewable Energy Site Assessments
      • Solar Site Assessment
      • Hydro Site Assessment
      • Wind Turbine Site Assessment
    • Renewable Rates
      • RGR Rate
      • RGS Rate
    • Solar with Haywood EMC
      • Certificate Of Completion
      • Typical Components Of A Solar Interconnected System
    • Contracts With Haywood EMC
    • Renewable Energy Information
    • Renewable Energy Sources
    • Interconnection With Haywood EMC
      • Interconnect Application