Get Certification Card Replacement Request Form - Baystate Health

This guide provides clear instructions for completing the Certification Card Replacement Request Form from Baystate Health online. By following these steps, you can ensure a smooth and efficient submission process for your card replacement request.

Follow the steps to successfully fill out the form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin filling out your name in the designated field. Make sure it is accurate, as this will be the name on your certification card.
3. Enter your complete mailing address, including city, state, and zip code. This information is crucial to ensure your card is sent to the correct location.
4. Provide your area code and phone number. This allows the organization to contact you if there are any questions regarding your request.
5. Select the type of certification card you are requesting replacement for (BLS/ACLS/PALS) by filling in the appropriate option.
6. Provide the instructor's name who conducted your class. This helps in verifying your certification.
7. Indicate the class date using the format Month/Day/Year to ensure clarity.
8. After completing the form, review all the information to confirm it is accurate and complete.
9. Include a replacement fee of $20.00 per card. Make checks payable to Baystate Continuing Education.
10. Return the completed form along with the payment to: Baystate Continuing Interprofessional Education, 361 Whitney Ave, 2nd floor, Holyoke, MA 01040, Attention: Kimberly Demerski.
11. Once your form and payment are received, your card will be mailed to you within 1-2 weeks.

Complete your Certification Card Replacement Request Form online today!