This form allows submission of an HVA Recertification Application online with payment of applicable recertification fee ($200/Current Member and $495/Lapsed Member*) by credit card. *Lapsed member fee includes ASDIN membership for remainder of the membership year from date of recertification application.

We ask that the required documentation be assembled into one PDF document and uploaded to this form before submission.

Please note that the PDF file should be named using a standard format: Your Last Name_Your First Name_Type of Recertification.pdf.  Example:  Smith_John_HVA Recert.pdf.

DO NOT SEND PATIENT IDENTIFIERS IN ANY OF THE PAGES SUBMITTED. PLEASE REVIEW CASE/PROCEDURE NOTES, CASE LOG AND CQI DOCUMENTATION TO ASSURE THAT PATIENT NAMES ARE REMOVED. YOUR APPLICATION WILL BE RETURNED TO YOU AND WILL NOT BE PROCESSED UNTIL AN APPLICATION WITHOUT PATIENT IDENTIFIERS IS SUBMITTED.

If you would like to add Optional Advanced Procedures at time of Recertification, you may select the additional $100 fee - here.