ABWMS Application for Certification in Wound Medicine and Surgery

ABWMS Application for Certification in Wound Medicine and Surgery
Application Directions
1. Read the ABWMS Handbook for Candidates before completing this application: the Handbook lists all documentation that will be needed to complete your application and information regarding fees and refund policies.

2. Complete application and upload supporting information including primary board certificate or board eligibility documentation.

3. If you are requesting test accommodations, refer to information here and have the Test Accommodations Form completed by your healthcare provider prior to proceeding

4. Pay the required fee

5. Please complete the application in its entirety before submitting. If you need to leave the application and come back for any reason, you may choose to save your progress by clicking the Save button at the bottom of the application. A link to return to the application will be sent to your email.

6. You will receive a copy of the completed application to your email.
Candidate Name

Enter your name EXACTLY as it appears on your government-issued photo identification.
First Name*
Middle Name
Last Name*
Degree Designation*

M.D.D.O.Other
Mobile Phone*
Email Address*

Confirmation EmailThis email address will be used to communicate important information about your exam. Please ensure it is correct.
Home Address
Street Address

Street Address Line 2

CityState

Zip Code
Work / Business Address
Company / Institution*
Position*
Department*
Room Floor
Building
Street Address

Street Address Line 2

CityState

Zip Code
Request for Test Accommodations
Are you requesting test accommodations and have a disability covered under the Americans with Disabilities Act?*

YesNo
If yes, fill out the Testing Acccommodations Form here in addition to this application.
Examination and Certification Information
Have you taken this examination before?**

YesNo
Are you currently or have you ever been certified in Wound Medicine and Surgery by ABWMS?**

Never certifiedCurrently certifiedPreviously certified
Medical License Information
License number*
License State*
Submit a copy of current physician license with Application*

File type must be one of the following: pdf, doc, docx, xls, xlsx, csv, txt, jpg, jpeg, png
Cancelof
Eligibility and Background Information
Current primary board certifications: (Check all that apply)*

ABMSAOAOther
Select your primary medical specialty or specialty board*
Submit a copy of your Primary Board Certificate*

File type must be one of the following: pdf, doc, docx, xls, xlsx, csv, txt, jpg, jpeg, png
Cancelof
How many years of experience do you have in wound care*
What percentage of your practice is devoted to wound care*
Indicate your primary practice area*
How did you first come to learn about ABWMS?*

ABWMS WebsiteColleagueHospital AdminOther
Other Information
Note: Information related to race, age, and gender is optional and is requested only to assist in complying with general guidelines pertaining to equal opportunity. Such data will be used only in statistical summaries and in no way will affect your test results.
Race/Ethnicity:

African AmericanAsianHispanicNative AmericanWhiteOtherPrefer not to say
Age Range:

Under 2525 to 2930 to 3940 to 4950 to 5960+Prefer not to say
Gender:

MaleFemalePrefer not to say
Candidate Statement and Signature
- I verify the information I entered is accurate and complete.
- I confirm that I have read the ABWMS Handbook for Candidates and understand that I am responsible for knowing all information and policies noted within.
- I acknowledge that once my application is submitted, I will not be able to modify any information on my application.
- I understand that my eligibility for this examination may be verified through the certifying organization.
- I understand that my application will be considered pending until American Board of Wound Medicine and Surgery (ABWMS) has received payment of the application fee.
- I understand that the demographic information I provided will only be used for statistical purposes in aggregate form.
- I confirm that the examination, fees, and testing window listed on this page are correct.
By checking this box I verify all of the above statements.
Please Type Your Name as Confirmation*
Payment and Submission of Application
You will also receive a copy of the completed application to your email.

Testing Window: click here to view the upcoming testing windows

Application Certification Fee: $850.00
For which testing period are you applying?*

JuneDecember

Application Fee*

Certification Exam Fee

$850.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Status
Should be Empty:

ABWMS Application for Certification in Wound Medicine and Surgery

Application Directions

Candidate Name

Home Address

Work / Business Address

Request for Test Accommodations

Examination and Certification Information

Medical License Information

Eligibility and Background Information

Other Information

Payment and Submission of Application