Home Certificate Recovery
  • Facebook Page: 227814447250935
  • Twitter: LoveHealthSvc
 

Certificate Recovery

Generated with MOOJ Proforms
* Required information.
Who should use this form?

You should use this form if you need another course completion card.
First Name * As it appears on the roster/sign in sheet
Last Name * As it appears on the roster/sign in sheet
Street Address * Course completion cards will be sent to this address
Street Address 1
City *
State *
Postal Code *
Contact Phone * May be used to call you for more information
Phone Type *
Email *
Email Type *
Estimated/Actual Course Date *
Instructor's Name If you know it...helps us narrow down our search
Course Location * Example - Frederick, MD or ABC Medical office in Anytown USA
Helpful Notes Things that help us not go hummmm?

 

Please note there is a $20/compltion certificate fee for this service. A card will not be issued until we verify the data from this form matches the data in our student database. It is important that you use the name used (as it was spelled) on the course roster when you took the course. We may email or call you for clarification of information. All cards will be issued with original course date and expiration that matches the expiration period (if it applies to the course you took).

Joomla Templates by Joomlashack