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Massachusetts Electric Outage Life Support Form

What is Outage Life Support? 

Outage Life Support provides phone notification to households where life sustaining equipment is in use so that Life Support Customers can make all necessary arrangements to plan for possible disruption to their electric service during an extended planned or unplanned electric outage. 

It is important to understand that participation in the Life Support Program does not protect your account from termination of service for non-payment of arrears. We encourage you to pay any arrears on your account as soon as possible. If you require protection from termination on your account due to the presence of a serious or chronic illness in the household, please apply separately with our Customer Protections Form.

Also note- Outage Life Support does not sign your account up for a higher priority for restoration if there is an outage.  

Please fill out the below information, which will be submitted securely to our processing team.

* indicates required fields
Customer Information







This needs to be a good, working phone number that you are reachable at in order to receive emergency notifications concerning planned or unplanned outages.
Patient information


MM/DD/YYYY

Life Sustaining equipment 


The Following are generally not considered life-sustaining: oxygen PRN, sleep apnea machines for patients over 6 months of age (CPAP, BiPAP, APAP, VPAP), nebulizer, ICD, AED, pacemaker, spinal cord stimulator, life alert, air conditioning, refrigerated medication, electric bed, electric air mattress, electric lift, electric wheelchair/lift. A doctor can certify you require electric or gas service due to one of these by submitting our Medical Protection application.
Third Party Notification
This program allows you to select a person to act on your behalf if you receive a collection notice from us. We will send a copy of any collection notice to your third party who can look into the situation and help make arrangements. The third Party can be a trusted friend or relative. However, the third-party is NOT resopnsible for nor obligated to pay your bill

Third Party Information