American Board of Clinical Neurophysiology

Recertification Form


 *
 YesNoNot Eligible
I hold a current medical license:
 *
 ABPN EpilepsyABEM EMGNoneNot Eligible
I have complete the ABPN Subspecialty Examination in Clinical Neurophysiology (Added Qualification in Clinical Neurophysiology):
 *
 NeurologyPsychiatryChild Neurology
I have Subspecialty Boards in:

Recertification Fee *
I have read the Candidate Handbook and Recertification Information, and understand that I am responsible for knowing their contents. I certify that the information given in this Application is in accordance with instructions and is accurate, correct and complete *
2908 Greenbriar Dr., Suite A | Springfield, IL 62704 | Ph. 217.726.7980 | Fax. 217.726.7989