ABPM International

Email Address *

1 | Exam Selection

2023 ABPMi Board Certification Exam

$ 350.00 USD

Application Deadline: Jan 29, 2023

2 | Contact Information

Marked fields are required.

First Name *

Middle

Last Name *

Date of Birth *

Office Phone *

Home Phone

Cell Phone

Fax Number

3 | Mailing Address

The address you enter must be a daytime address at which you can receive mail requesting a signature.

Address Line 1

Address Line 2

City

State/Province/Region

Zip/Postal Code

Country

4 | Public Address

If you do not provide a second address, your mailing address will be used as your public address.

Copy Mailing Address

Address Line 1

Address Line 2

City

State/Province/Region

Zip/Postal Code

Country

5 | Education

Enter your 4-digit graduation year beside each school you have attended.

Year

Institution

City

State/Province/Region

Country

Evidence of Graduation

6 | Licenses/Registrations

Upload a copy of each current license for the locations in which you hold a podiatry license.

Add A License

I Have No Licenses to Upload.

7 | Test Accommodations

ABPMi is committed to providing access for all individuals with disabilities. At the request of ABPMi, Pearson VUE provides reasonable test accommodations for candidates with specific needs who provide timely and adequate documentation on a case-by-case basis. It is essential for applicants requesting special accommodations to submit supporting documentation at the time of submission. That will assist, but not guarantee, the candidate obtaining accommodation at a test center proximate to their point of origin.

I am requesting special accommodations.

Add a Supporting Document

ABPMi will notify you via e-mail once accommodation is approved and advise you on how to schedule your appointment.

8 | Ethics

1) Have any diciplinary actions been initiated and/or are any pending against you by any state licensure board?

2) Has your license to practice medicine in any state been denied, limited, suspended, revoked placed on probation or involuntarily relinquished?

3) Have you been suspended, sanctioned or otherwise restricted from participating in any private or national health insurance program?

4) Have you been the subject of any investigation by any private, federal or state agency including Professional Review Organizations, concerning you par ation in any private, federal or state health insurance program?

5) Have you ever been convicted of a felony or misdemeanor other than minor traffic violations?

If you answered Yes to any of the above questions, please explain:

9 | Solicitation by Other Organizations

The ABPMi will refer candidate information to organizations delivering educational content, or soliciting professional membership in areas relevant to the specialty unless specifically declined by the candidate.

I do not wish my name to be provided to other organizations by the ABPMi.

10 | Disclosure

The information provided on or attached to this application is complete to the best of my knowledge. I fully understand and agree that, as a condition of making this target, any misrepresentation, misstatements, or omissions, whether intentional or unintentional, may constitute cause for automatic and immediate rejection of this applications and/or membership classification achieved with the ABPMi.

11 | Acknowledgement of Dues

I acknowledge that upon passing the certification exam, I will be required to pay annual dues of $200.00 USD to maintain certification.

Putting Pins on the Map