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DTE Energy Medical Certification Form (Michigan)

DTE Energy customers request a medical hold on shutting off gas or electric service with this Michigan Public Service Commission-approved form. A physician or public health official certifies a medical emergency, which postpones shutoff for 21 days and up to 63 days with further certificates, or critical care status for patients on home medical or life-support equipment, which postpones shutoff on an annual basis.

Who completes it

Section 1 is completed by the patient, or a parent or guardian for a patient under 18, who authorizes release of the medical information. Section 2 is completed by the DTE account holder. Section 3 is completed by the physician or public health official, who checks one condition type, describes it, and signs.

Submitting and payment

How to submit it
The customer returns the form and valid identification through DTE's website or by email within 3 business days; DTE processes completed forms within one business day.
Who pays
The form lists no fee for the clinician's certification.

Good to know

  • For a medical emergency, the clinician lists the conditions that loss of electricity or natural gas would aggravate, any equipment, and the time period.
  • Critical care requires listing the life-support system or medical equipment and is renewed annually with a new form; the patient agrees to tell DTE when the hold is no longer needed.
  • DTE cannot guarantee continuous service; the household must keep backup power or an alternate plan, and the hold gives no restoration rights in an unexpected outage.
  • The fillable PDF uses the same MPSC-approved wording as Consumers Energy and other Michigan utilities, so the clinician section looks the same across them.

Get the official form

Download the current version from the source each time; forms change without notice.

Medical Certification Form

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

How long does a DTE medical emergency hold last?

DTE suspends shutoff for 21 days after a valid medical emergency certificate. More certificates are needed to extend the hold, and postponement for medical emergencies cannot exceed 63 days in total. Critical care holds last a year and require a new form annually.

What does the clinician certify in Section 3 of the DTE form?

That they examined the patient and the patient meets the criteria for a Medical Emergency Patient (a condition aggravated by lack of utility service) or a Critical Care Patient (home life-support equipment where termination would be immediately life threatening). The clinician adds license number, business contacts, signature and date.

Does an approved DTE medical hold stop shutoffs permanently?

No. DTE's instructions say approval does not prevent shutoffs indefinitely, and the customer must take steps to resolve unpaid bills. DTE points customers to assistance programs and to United Way's 211 service for help paying utility bills.