Get the free Medical Extension Request form. Medical Extension Request form

Medical Extension Request A ccording to Colorado Springs Utilities Rules and Regulations a customer may provide a signed Medical Certificate to postpone the discontinuance of utility service. Org Fax 719-668-8175 In-Person Customer Service Center 111 South Cascade Avenue Mon. Fri. 8 a.m. to 5 p.m. Disclaimer All completed forms will be verified upon receipt for final approval. If the customer chooses to fax or email the completed forms the customer willingly accepts all risks related to...

How to fill out medical extension request form

How to fill out medical extension request form

1. Read the instructions provided with the medical extension request form.
2. Make sure you have all the necessary information and documents ready.
3. Start by providing your personal details such as name, address, contact information, etc.
4. Specify the reason for requesting a medical extension and provide any relevant medical documentation or reports.
5. Include the date on which the medical extension is required and the duration for which it is needed.
6. Fill out any additional sections or questions as required by the form.
7. Double-check all the information you have provided for accuracy and completeness.
8. Sign and date the form, indicating your consent and understanding of the information provided.
9. Submit the completed form to the appropriate authority or department as instructed.
10. Keep a copy of the filled-out form for your records.

Who needs medical extension request form?

1. Individuals who require additional time for medical treatment or recovery.
2. Patients who need to extend their medical leave from work or school.
3. People who are undergoing medical procedures and require an extension for necessary follow-up appointments.
4. Individuals who have suffered from a serious illness or injury and need to request an extension for insurance or disability claims.
5. Patients who need to request a medical extension for ongoing therapy sessions or rehabilitation programs.

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