Who completes the Residential Critical Care and Chronic Condition Application?

The applicant completes Part 1 and provides it to the patient's physician, who completes Part 2. The applicant then returns the signed application to the City.

How do I submit the application to Boerne?

Submit it to Utilities Customer Care and Billing in person at City Hall, by mail, email, or fax using the contact details listed on the application.

Do I need a notary for the Residential Critical Care and Chronic Condition Application?

No. The applicant and physician sign the application; it does not require notarization. No sworn or notarized attachment is identified.

Boerne, TX · Kendall County

No notary required

Residential Critical Care and Chronic Condition Application

Boerne utility customers use this application to request critical care or chronic condition designation and provide information for a physician to complete.

What this form is

This application lets a residential electric customer request Critical Care or Chronic Condition designation so Boerne Utilities can prioritize notices of planned power outages. The customer completes Part 1, and the patient's physician completes Part 2; the application asks for customer, patient, emergency contact, and physician information, along with signatures and a date. Approval is not automatic, and the designation does not guarantee continuous power.

Who needs it

A Boerne residential electric customer seeking designation for a patient who relies on electric-powered medical equipment or heating or cooling should complete this application.

How to submit it

Return the signed application to Utilities Customer Care and Billing in person at City Hall, by mail to P.O. Box 1677, Boerne, TX 78006, by email to [email protected], or by fax to (830) 249-2580.

About notarization

This application is signed by the applicant and physician without a notary; the signer just signs and dates it, and no sworn or notarized attachment is identified.

How to submit this form

1
Download The Application
Download the Residential Critical Care and Chronic Condition Application.
2
Complete Part 1
The applicant fills in Part 1, including the customer, patient, and emergency contact information, or marks the option to decline an emergency contact.
3
Have The Physician Complete Part 2
Provide the application to the patient's physician to complete Part 2, including the medical condition and physician information.
4
Sign And Submit
Sign and date the application, then return it to Boerne Utilities Customer Care and Billing in person, by mail, email, or fax.

Frequently asked questions

Who completes the Residential Critical Care and Chronic Condition Application?: The applicant completes Part 1 and provides it to the patient's physician, who completes Part 2. The applicant then returns the signed application to the City.
How do I submit the application to Boerne?: Submit it to Utilities Customer Care and Billing in person at City Hall, by mail, email, or fax using the contact details listed on the application.
Do I need a notary for the Residential Critical Care and Chronic Condition Application?: No. The applicant and physician sign the application; it does not require notarization. No sworn or notarized attachment is identified.

Need something notarized?

This Residential Critical Care and Chronic Condition Application doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.