Section 1 of 1 in this document

APPLICATION FOR MEDICAL REAR DOOR SOLID WASTE SERVICE

In accordance with the Solid Waste Franchise Agreements, the hauler will offer side-door or front-of-house service at no extra charge for residences where occupants are physically unable to bring refuse to the curb.

To apply for this service, you must submit a physician’s verification confirming that you are unable to transport refuse to the curb. We only need confirmation of your functional limitation — no detailed medical diagnoses or personal health information.

This application applies only to recycling and big bin service; yard-waste service is not included in the medical non-curbside program.

Preferred method of contact

Home Phone

Cell Phone

Home Phone

Cell Phone

Please acknowledge the statement below by typing 'yes' in the provided box. "I am unable to place my garbage and recycling containers at the curb due to the following physical limitation, disability, or handicap."

Is the physical limitation, disability or handicap stated above a permanent or a temporary condition?

Permanent

Temporary

If the physical limitation, disability, or handicap is temporary, how long do you anticipate the condition will exist?

Please mark the location of refuse:

Side Door

Front of House

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Please Provide Doctor Authorization Documents

Click Here to Upload

Your application will be reviewed, and a staff member will contact you regarding approval or denial.