BVES, Inc.
Medical Baseline Program Application
The Medical Baseline Program is an assistance program for residential customers who depend on power for certain medical and independent living needs. To qualify, a full-time resident must have a qualifying medical condition and/or require use of a qualifying medical device to treat ongoing medical conditions.
Learn more about the Medical Baseline Program
If you need assistance, contact BVES, Inc. at 1-800-808-2837.
Fields marked with an asterisk (*) are required.
Customer
Service Address
Mailing Address
If different from Service Address.
Emergency Contact
Please make sure BVES, Inc. has your emergency contact preferences so we can reach you in advance of planned public safety power shutoffs (PSPS) or other situations that may result in an outage.
I certify that the above information is correct. I also certify that the Medical Baseline resident lives full-time at this address and requires or continues to require the Medical Baseline Program. I agree to allow BVES, Inc. to verify this information. I also agree to promptly notify BVES, Inc. if the qualified resident moves or no longer requires the Medical Baseline Program.
Type your full name to serve as your electronic signature.