THE AMERICAN BOARD OF PATHOLOGY
REPLACEMENT CERTIFICATE REQUEST FORM


The ABPath does not issue duplicate certificates. To request a replacement certificate to be engraved, complete and submit this form to the ABPath along with credit card authorization or check for $100.00. The replacement certificate will indicate that the certificate is a replacement and the date of the replacement. Do not check more than one certificate below. If more than one certificate needs to be replaced, a Replacement Certificate Request Form must be completed and submitted with payment for each certificate.

INSTRUCTIONS:
Please submit the full name and Last 4 digits of social security number or the Date Of Birth for each certificate request.
Requests will be completed in 5-7 business days.
Once this form is completed, please click the "Continue to the Payment page" button at the bottom to enter your payment on the next page.

Replacement Certificate type

The primary certificate I wish to replace is:
The subspecialty certificate I wish to replace is:

Reason for requesting a Replacement Certificate

Name and Title Preference

Information on physician requesting the Replacement Certificate

Send Replacement Certificate to:

$