American Health Source

Replacement of Certificate Request Form

Replacement of Original Certificate(s)
Please provide the following information to receive a replacement of either your AHS Membership Certificate or your NBCA National Certification Exam Certificate.  You will be directed to a Pay Pal payment link after submitting your order below.  The processing fee is $10 for each certificate.  AHS will process your request within 72 hours of receipt .

Name Change
Please submit proof of your name change to the AHS Office.  You must send us a copy of a legal court record such as a marriage license, divorce decree or court-approved name change document supporting the name change.  If you wish to have a new certificate reflecting your name change, please follow the directions above for the Replacement of Certificate(s).

Replacements of NBCA Exam Certificates are only available to currently certified professionals in good standing.  If your certification has lapsed - no certificate will be provided.  No Refunds.

Request Replacement Here

Name Change Requirement:  If you a requesting a certificate and you have had a name change, you must submit the required documentation directly to us using the "print and mail" form along with the required supporting documentation. Download "print and mail" now and submit directly to us.  Continue with this form only if you have not changed your name.
NOTE: certificate(s) will be sent to the address we have for you on file unless you indicate an alternative address below.
Your Name
Your Email Address
Home Phone with
Area Code
Your Street Address
City - State - Zip
Certificate ID
NAME: As you would like it printed on your certificate
NAME: As it now appears on your certificate
Enter SPAM Prevention
Code Displayed at Right


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