IBTHM Board Certification Application

Administered by the International Board of Trichology & Holistic Medicine (IBTHM)

SECTION 1 – Applicant Information

First name

Last name

Preferred Name for Certificate

Date of Birth

Month

Day

Year

Email

Phone

Mailing Address

Country/Region

Address

City

Zip / Postal code

Upload Government Issued ID

SECTION 2: Certification Level Applying For

Certification Level

SECTION 3 – Education & Training Verification

Highest Level of Education Completed

Name of Institution(s)

Field of Study or Certification Area

Date of Completion

Month

Day

Year

Upload Supporting Documentation (Accepted files: • Diploma • Certificate • Transcript • Training Certificate)

SECTION 4: Professional Experience

Are you currently practicing in your field?

Yes

No

Years of Professional Experience

Current Employer or Practice Name

Years of Experience in this Field

Upload: Resume or Portfolio if applying for Master Level or Doctoral Certification (optional for Practitioner Level)

SECTION 5 – Professional Conduct and Ethics

Have you ever had a professional license revoked or suspended?

Yes

No

Have you ever been subject to professional disciplinary action?

Yes

No

Have you ever been convicted of a felony related to professional practice?

Yes

No

If yes to any question in section 5, explain

SECTION 6: Declaration and Agreement

I certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that providing false or misleading information may result in denial or revocation of Board Certification.

I agree to uphold the ethical and professional standards established by the International Board of Trichology and Holistic Medicine (IBTHM).

Signature

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SECTION 7 – Application Fee (Non-Refundable)

Select the credential level you are applying for below. Each level represents a separate review and certification. If you wish to apply for more than one credential (for example, both Trichology and Holistic Health), please complete a separate application

Credential Level Fee

Practitioner (BCT / BCHHP)$295

Master (MT / BMHHP)$395

Doctoral (DTS / BDHHP)$595

I confirm that I have selected the correct certification level and understand that this application fee is non-refundable.