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To request a replacement EasyCTPA QR card, follow both steps below:

You must complete BOTH step 1 AND Step 2 below!


Your can pick up you new card from the doctor next time he is at school.

STEP 1: PAY $50

After making your payment, you MUST return to this page to complete step 2 below.

Pay by Cash APPPay by Venmo

STEP 2: SUBMIT FORM

Only fill out the form below after completing the payment in step 1.

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