---
title: Vulnerable Customer Registry Enrollment Form Template for Utilities | Paperform
description: Help utility customers with medical equipment needs, mobility limitations, or communication barriers register for priority support and emergency assistance during service interruptions.
url: "https://paperform.co/templates/vulnerable-customer-registry-enrollment-form"
type: static
generatedAt: "2026-03-28T00:45:32.886Z"
---

[← Back to free form templates](/templates/)    ![Vulnerable Customer Registry Enrollment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/vulnerable-customer-registry-enrollment-form.png)
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### Ensure Priority Support and Protection During Utility Service Interruptions

For customers with medical equipment dependencies, mobility limitations, chronic health conditions, or other vulnerabilities, utility service interruptions can be more than an inconvenience—they can be life-threatening. That's why municipal utility providers and water authorities maintain **vulnerable customer registries** to ensure at-risk households receive priority support, advance notice, and tailored assistance during planned maintenance or emergency outages.

If you or someone in your household relies on electrically powered medical equipment, has mobility challenges that make evacuation difficult, or requires specific communication accommodations, registering with your utility's vulnerable customer program is an essential step in safeguarding your wellbeing.

This **Vulnerable Customer Registry Enrollment Form** template makes it simple for utility providers—water, sewage, electricity, gas, and municipal services—to collect the critical information needed to protect their most at-risk customers. Built with Paperform, this form offers a compassionate, accessible experience for customers while giving utility teams the structured data they need to deliver priority services during outages and emergencies.

---

#### Who Should Use This Vulnerable Customer Registry Form?

This template is designed for:

 - **Municipal utility departments** managing water, sewage, electricity, gas, and waste services
 - **Public utility commissions** and government agencies responsible for essential services
 - **Energy providers** (public and private) offering customer protection programs
 - **Emergency management coordinators** ensuring vulnerable populations are accounted for during disasters
 - **Customer service teams** in utility companies who need to flag and support at-risk accounts

Whether you're a city utilities office, a regional water authority, or a public works department, this form helps you meet regulatory requirements, improve emergency response, and provide equitable service to all customers.

---

#### What Makes This Vulnerable Customer Registry Form Essential?

Vulnerable customer programs exist to bridge the gap between standard utility service and the unique needs of at-risk populations. This form template captures the right information to:

 - **Identify medical equipment dependencies** such as oxygen concentrators, dialysis machines, ventilators, and powered mobility aids
 - **Flag mobility and access challenges** that make evacuation or temporary relocation difficult during outages
 - **Accommodate communication needs** for customers who are deaf, hard of hearing, visually impaired, or speak languages other than English
 - **Document emergency contacts** who can assist the customer during service interruptions
 - **Prioritize restoration efforts** so vulnerable households are reconnected as quickly as possible
 - **Enable proactive outreach** with advance notice of planned outages, emergency alerts, and welfare checks

This isn't just a compliance checkbox—it's a lifeline for customers who need your utility services to stay safe and healthy.

---

#### Key Features of This Paperform Template

Paperform's flexible, accessible design makes it easy to build a vulnerable customer registry that works for everyone:

 - **Conditional logic** reveals follow-up questions only when relevant (for example, asking about medical equipment details only if the customer indicates a dependency)
 - **Multiple communication preference options** including phone, SMS, email, postal mail, and in-person visits
 - **Accessible formatting** with clear headings, descriptions, and support for screen readers
 - **WCAG-friendly design** ensuring customers with disabilities can complete the form independently
 - **Secure data collection** with encryption and SOC 2 compliance to protect sensitive health and personal information
 - **Integrated workflows via Stepper** to automatically route high-priority registrations to emergency management teams, flag accounts in your CRM or utility billing system, and trigger follow-up communications

This form is built to meet the needs of diverse populations, including seniors, people with disabilities, non-English speakers, and households managing chronic health conditions.

---

#### How Paperform Streamlines Vulnerable Customer Enrollment

Paperform is trusted by over 500,000 teams worldwide, including government agencies, municipal departments, and public service organizations. Here's how it helps you manage vulnerable customer registrations:

 - **No-code simplicity:** Your customer service or emergency management team can launch and update the form without IT support.
 - **Seamless integrations:** Send submissions to your CRM (like Salesforce or HubSpot), log them in Airtable or Google Sheets, or ping your operations team in Slack or Microsoft Teams.
 - **Automated workflows with Stepper:** Use Stepper (stepper.io) to create multi-step processes that flag vulnerable accounts in your billing system, send confirmation emails, schedule welfare checks, and assign follow-up tasks to caseworkers.
 - **Branding and trust:** Customize the form with your utility's logo, colors, and domain to build trust with customers who may be wary of sharing sensitive health information.
 - **Multilingual support:** Easily duplicate and translate the form into Spanish, Mandarin, or other languages spoken in your community.

---

#### Real-World Use Cases for Utility Vulnerable Customer Registries

This form can be used across a range of municipal and utility services:

 - **Water and sewage utilities** identifying customers who need bottled water delivery or portable sanitation during service interruptions
 - **Electricity providers** prioritizing restoration for customers with medical equipment or extreme temperature vulnerabilities
 - **Gas utilities** ensuring safe communication with customers about service shutoffs and carbon monoxide risks
 - **Emergency management offices** coordinating with utilities to support at-risk populations during natural disasters
 - **Public works departments** offering accessible communication and assistance during infrastructure projects

When an ice storm knocks out power, a water main breaks, or a planned outage is scheduled, having an up-to-date vulnerable customer registry means your team can act fast to protect the people who need you most.

---

#### Compliance, Security, and Trust

Vulnerable customer data is sensitive and must be handled with care. Paperform is **SOC 2 Type II compliant and GDPR-ready**, with enterprise-grade encryption, data residency controls, and role-based permissions to ensure only authorized personnel can access submissions. While Paperform is not HIPAA compliant, it meets the security standards expected by public sector organizations managing personal and health-related information.

For government agencies, this means you can confidently collect, store, and act on vulnerable customer registrations without compromising privacy or regulatory compliance.

---

#### Get Started with This Vulnerable Customer Registry Template

Whether you're launching a new customer protection program or modernizing an existing paper-based registry, Paperform makes it easy to create an accessible, secure, and efficient enrollment process. Customize this template to fit your utility's services, integrate it with your existing systems via Stepper, and start protecting your most vulnerable customers today.

Trusted by public sector teams around the world, Paperform helps you deliver equitable, responsive service to every customer—especially those who need it most.
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