Medical Certificate Request
The following information needs to be provided in its entirety. Without this information, Duke Energy will be unable to process the request for a Medical Certificate. If the customer is eligible, the Medical Certificate will be faxed to the physician's office for completion.
- Physician's office requesting this form does not guarantee approval.
- Request completed before 4:00 p.m. will be faxed same day. If received after 4:00 p.m. the medical certificate will be faxed next business day.
**Attention: If Services have been DISCONNECTED, Please call 1-800-544-6900. **
* Indicates a required field.