Board of Naturopathic Gastroenterology Board Certification Application

Use this form to apply for the Board of Naturopathic Gastroenterology Board Certification exam. Please review the application information and the case study grading rubric prior to completing this form. If you need to save your form and return to it later, there is a button to do so at the bottom of the form. Please note that if you choose the save and continue option, the partially completed form will be available for 30 days, and uploaded case study files will not be saved. It is recommended that you have your application information accessible when completing this electronic application. The application fee is $250. The application deadline, including payment, is March 7, 2022.

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Section 1: General Information

Name*
Address*

Section 2: Education and Licensing

State/Province, License #, Year Licensed (List All)

Section 3: Demonstrable Clinical Experience in Naturopathic Gastroenterology (must meet at least one criterion in each of the following three categories)

Category 1 - Experience*
* If applying under the "residency" category, you must submit quarterly recap forms from your residency director. ~ Note: GI patient contact hours are defined by care that you are providing or directly supervising that relates to an underlying GI complaint and/or associated conditions.
Category 2 - Cases (see format and guidelines)*
Please provide 5 individual patient cases that cover varying GI conditions. For all cases, the chief complaint or diagnostic findings must be directly related to one or more of these organs: esophagus, stomach, pancreas, liver, gallbladder, small and large intestines. Please review the case grading rubric prior to submission. All cases are to be submitted electronically, with patient identifying information removed (use patient initials only). Case submissions will be blinded prior to review by the board certification committee.
Accepted file types: doc, docx, pdf, Max. file size: 256 MB.
Accepted file types: doc, docx, pdf, Max. file size: 256 MB.
Accepted file types: doc, docx, pdf, Max. file size: 256 MB.
Accepted file types: doc, docx, pdf, Max. file size: 256 MB.
Accepted file types: doc, docx, pdf, Max. file size: 256 MB.
Category 3 - Continuing Medical Education*
I affirm that I have obtained at least 100 hours of documented naturopathic gastroenterology continuing medical education within the last 3 years. Naturopathic Gastroenterology continuing medical education means any Continuing Medical Education approved or approvable by any state or provincial naturopathic licensing board for the purposes of relicensing or approved by the Accreditation Council for Continuing Medical Education (ACCME), which is directly relevant to the practice of naturopathic gastroenterology.

Section 4: Applicant Signature

Type your full name and professional credentials

Section 5: Payment

Product Name*
This field is for validation purposes and should be left unchanged.