Medical Disability Discount Form

Under Marin Water’s Medically Disabled Water Rate Program, qualifying customers are eligible to have the bimonthly service charge and watershed management fee waived. Customers enrolled in the program also receive an additional 12 CCFs of water billed at the Tier 1 rate (one CCF, or hundred cubic feet, is 748 gallons). 

Please review program requirements before submitting your application. 

Program Requirements and Details

The Medically Disabled Water Rate Program is not retroactive. Customers who qualify will begin receiving the rate during the billing cycle following approval of their application.

To Qualify

To qualify, you must:

1. Establish your disability requiring use of additional amounts of water related to the disability through doctor verification. Verification form: English | Spanish

2. Be a separately metered district single-family or multi-unit residential customer not served through a master meter.

3. Use, per billing period, on average in excess of the amount of water specified in Section 6.01.025 for Billing Code 1 at Tier 1.

4. Install water-efficient showerheads, toilets, and faucet aerators in your home that comply with Marin Water requirements Code (free showerheads and aerators are available from Marin Water).

The Renewal Process

• If the Doctor of Medicine or Osteopathy, licensed to practice medicine in the State of California, certifies the medical condition is permanent, Marin Water requires completion of a form every four (4) years self-certifying the customer’s continued eligibility for the Medically Disabled Water Rate program.

• If the Doctor of Medicine or Osteopathy, licensed to practice medicine in the State of California, certifies the medical condition is not permanent, Marin Water requires completion of a new application including a qualified medical practitioner’s certification every two (2) years or following the date of recovery, whichever period is shorter. Following expiration of the two (2) year period or date of recovery, new application must be submitted for further consideration and enrollment in the program.

If you have any questions about this program or other discount programs available, please contact Customer Service at 415-945-1400 or visit marinwater.org/discounts. We will notify you in writing as to whether or not you qualify for this program.

Please note: The District reserves the right to request additional information at any time. Participation in the program may be revoked if a customer does not meet all qualifying criteria as set forth herein and in the District Code (6.01.100).

The Medical Disability Discount Program requires a Doctor’s Certification. Please download, complete, and attach the Medically Disabled Water Rate Program Application & Doctor’s Certification Form as part of the below application process. 

English form | Spanish form

If you prefer to apply in person, or via mail, contact Customer Accounts & Billing at 415-945-1400, or visit our Administrative Offices, 220 Nellen Ave., Corte Madera, during normal business hours (8 a.m. to 4:30 p.m. Monday-Thursday).