Priority Services Registration Form

You can be included in our Priority Services Register if you are:

  • Dependent on medical equipment
  • Chronically sick
  • Disabled
  • Or have some other special needs you would like us to consider

Being on our register won't necessarily mean we can restore your power more quickly, however we will try to proactively contact you if we know of a problem in your area.

If you meet the criteria outlined above and would like to take advantage of this service, please complete the online form below. Please note that fields marked with an asterisk * are mandatory.

If you would like a security password please write it here, using no more than 10 letters.

I confirm that the details I have given are true and correct.
I give permission for you and other organisation to store and use my personal details so that you can provide me with priority services. I understand that, by law, you are allowed to use my personal details once I have given my permission.

If you would like us to hold contact details of someone who may contact us on your behalf, please provide their name and telephone number below.

Please tell us about your needs below by ticking all the boxes that apply to you. You must tick at least one box.

I have a nebuliser
I have a heart/lung machine
I rely on kidney dialysis equipment
I have an oxygen concentrator
I have a ventilator
I have an apnoea monitor
Other medical dependency on electricity

Please provide details:

I am blind
I am partially sighted
I am deaf
I am hard of hearing
I have a stair lift
I have a bath hoist
I am aged over 60
I am disabled
I have speech difficulties
English is not my first language

Please provide details:

I have learning dificulties
I have restricted movement
I have dementia
I am seriously ill

Please provide details:

To ensure smooth handling of your enquiry please ensure you complete all fields and provide the information requested