Create an Account - Increase your productivity, customize your experience, and engage in information you care about.
( to be completed by attending physician)
It is my professional opinion that his/her inability is permanent. ________
It is my professional opinion that his/her inability is temporary._________
The temporary inability is anticipated to end _____________
Please Type or Print
(To be completed by resident requesting service)
In accordance with the physician's verification above, I am physically unable to transport my household refuse to the curb for collection. I further verify that there is no able-bodied person regarding at my residence who is capable of transporting my refuse to the curb for collection.
* indicates a required field