Retirement Status Request / Consent Form

For more information on ABO Retired Status, please email Kerry@AmericanBoardOrtho.com.

Name *

Email Address *

By completing this form, I would like to request that the ABO change my status from Active to Retired. I am confirming that I meet one of the following Retired status eligibility requirements:

I am fully retired from the active practice of Orthodontics with no significant compensation from teaching or other allied professional activities.
I am still practicing, teaching, or receiving other compensation from allied professional activities, but I am 65+ years of age and have paid my annual dues consistently for 10+ years prior to my request.

I understand that I will no longer be required to pay ABO annual fees, and I will be listed under Retired status on the ABO Orthodontist Locator.

I understand that the automated verification system will respond to any third party inquiries with my updated ABO Retired status. Third parties may include insurance companies, state dental boards, hospitals, etc.

I understand that, should I choose to reinstate my status from Retired to Active in the future, I may be required to pay a reinstatement fee and/or be required to complete certification renewal requirements in accordance to the Certification Deactivation and Reinstatement Policy prior to reinstatement being granted.

Please check this box if you would like to continue receiving ABO communications.

Additional Comments

American Board of Orthodontics

401 N. Lindbergh Blvd., Suite 300
St. Louis, MO 63141-7839

(314) 432.6130

(800) 853.6130

(314) 432.8170

info@AmericanBoardOrtho.com