Applicant Information

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American Academy of Oriental Medicine Family
Practitioners
619 East 6th Street ▫ Texarkana, AR 71854 ▫ (870) 772-8622
[email protected]
The American Academy of Oriental Medicine Family Practice A.A.O.M.F.P was established
in 1997 as a post-graduate educational program offering classes and internships leading to
board certification in Oriental Medicine Family Practice/Diplomat Oriental Medicine Family
Practice (D.O.M.F.P.) or a certificate in advanced Oriental Medicine techniques.
The Diplomat program and the advanced Oriental Medicine techniques certification
program both include training in all injection modalities.
The A.A.O.M.F.P. Programs are open to all Doctors of Oriental Medicine / Acupuncturist.
A.A.O.M.F.P. programs may be available to other professionals upon A.A.O.M.F.P. board
approval of their application.
The A.A.O.M.F.P. also offers assistance to state Oriental Medicine Societies involved in
legislation for advanced Oriental Medicine procedures. At present we are an approved
continuing education provider by the following state boards, professional groups and
agencies.
Arkansas State Board of Acupuncture and Related Techniques
West Virginia Board of Acupuncture
Florida Board of Acupuncture
New Mexico Board of Oriental Medicine-In Application.
_______________________________________________________________
o National Certifying Commission for Acupuncture and Oriental Medicine
N.C.C.A.O.M. Professional Development Activity (PDA) provider.
_______________________________________________________________
o AOMNC-Acupuncture & Oriental Medicine National Coalition.
o American Association Of Oriental Medicine A.A.O.M.
o Arkansas Association Of Oriental Medicine Ar-AOM
_______________________________________________________________
o We are in application for accreditation as a postgraduate specialty program in
Oriental Medicine Family Practice from the National Oriental Medicine
Accreditation Agency. (N.O.M.A.A.)
_______________________________________________________________
o
o
o
o
The A.A.O.M.F.P. is constantly updating our curriculum and applying for
provider status in other states.
Board Members/ Instructors
Dan Martin D.O.M., O.M.D., D.O.M.F.P, Director / Instructor
Joe Gallucci D.Pharm.
Copyright 2005 Dan Martin D.O.M.
1
Libby Moody D.O.M., R.T., D.O.M.F.P. Instructor
Dayna Cigainero M.A.
Bob English D.C. Instructor
Board Members/Instructors con’t
Libby Moody D.O.M., R.T., D.O.M.F.P.
Bob English D.C.
Richard A. Freiberg, O.M.D., N.M.D., D. Ac, A.P.
Instructors at large;
Janice Vigh D.O.M., Dipl. C.H. D.O.M.F.P.
Julia Rader O.M.D, D.O.M, CA. D.O.M.F.P.
Judy Brown F.N.P., certified nurse practitioner.
Alicia Wyatt D.Pharm.
James Sheets D.Pharm
Pat Billingsley E.M.T.-paramedic
Advisors
Charlotte James, O.M.D., N.M.D., A.P., D.N.B.H.E,
David N. Sontag, O.M.D, A.P., D.C.O.M.F.P
Paul J. Reinhardt, M.D., N.M.D., I.M.D.
Richard A. Freiberg, OMD, NMD, D. Ac, AP
Joe Gallucci D.Pharm.
Al Stone, O.M.D
Darrell Samples, O.M.D.
Legal
Darren Anderson J.D.
Copyright 2005 Dan Martin D.O.M.
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American Academy of Oriental Family
Medical Practitioners
619 East 6th Street ▫ Texarkana, AR 71854 ▫ (870) 772-8622
[email protected]
Applicant Information
Full Name:
Last
Date:
First
M.I.
Address:
Street Address
Apartment/Unit #
City
Phone:
(
State
)
ZIP Code
E-mail Address:
Education
College:
Address:
YES
From:
To:
Other:
Degree:
Address:
YES
From:
NO
Did you graduate?
To:
NO
Did you graduate?
Degree:
What is/are your professional discipline/s?:
State license and license number:
References
Please list three professional references.
Full Name:
Relationship:
Clinic:
Phone:
(
)
Phone:
(
)
Address:
Full Name:
Relationship:
Clinic:
Address:
Copyright 2005 Dan Martin D.O.M.
3
Full Name:
Relationship:
Clinic:
Phone:
(
)
Address:
Courses
Tuition is $500.00 per module.
Textbooks will be available at suggested retail cost. For a list of required
textbooks contact A.A.O.M.F.P. and Deanna @870-772-8622.
2006 Class schedule:
February 23, 24 & 25. Instructor TBA
Trigger Point Injection Therapy: Basic Science and Technique –10 hours .
Neural Therapy – 5 hours.
Prolotherapy: Basic Science, Clinic Studies, and Technique – 10 hours.
Point Injection Therapy - 5 hours.
*Practical and written exam included.
_________________________________________________________________________________
March 23, 24, 25 & 26.
Part 1. Intravenous Therapy – 80 hours.
-EDTA 40hours.
-Oxidation15 hours.
-Plaquex 10 hours.
-Myers Multi Vitamin /Mineral.15hours.
*Practical and written exam included
________________________________________________________________________________
April 26, 27, 28 & 29. Instructor TBA
Part 1. Intravenous Therapy – 80 hours.
-EDTA 40hours.
-Oxidation15 hours.
-Plaquex 10 hours.
-Myers Multi Vitamin /Mineral.15hours.
*Practical and written exam included
________________________________________________________________________________
May 24, 25, 26 & 27. . Instructor TBA
Western Physical Examination – 10 hours.
X-Ray Interpretation –10 hours.
Western Orthopedic and Neurological Evaluations – 20 hours.
Blood Chemistry and Urinalysis basic – 10 hours.
Copyright 2005 Dan Martin D.O.M.
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*Practical and written exam included.
________________________________________________________________________________
June 22, 23 & 24. . Instructor TBA
Western Pharmacology I – 20 hours.
BHRT Bio Identical Hormone Replacement Therapy I– 12 hours.
Homeopathic Medicine Injections-5 hours.
Clinical Nutrition –5 hours.
*Practial and written exam included.
_________________________________________________________________________________
July 27, 28 & 29. Instructor TBA
Western Pharmacology II – 20 hours.
BHRT Bio Identical Hormone Replacement Therapy II– 12 hours.
Clinical Nutrition –5 hours.
August 24, 25 & 26.
8.Oxygen Therapy – 5 hours.
17. Mesotherapy Injections 12 hours
18. Anaphalaxis management –10 hours
*Practical and written exam included.
Advanced Oriental Medicine Techniques Certification Course – 346 hours
Copyright 2005 Dan Martin D.O.M.
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Diplomat in Oriental Medicine Family Practice.
To become Board Certified in Oriental Medicine/ Diplomate in Oriental Medicine Family Practice you
must complete ALL of the following.
1.
2.
Advanced Oriental Medicine Techniques Certification Course –310hours.
The following additional modules.
Advanced Oriental Medicine Injection Techniques 15 hours.
Hypothyroidism evaluation diagnosis treatment strategies 15 hours.
Candidiasis and associated conditions treatment strategies 20
Oriental Medicine Cancer strategies. 20 hours
Bio -Terrain and darkfield microscopy 20hours.
3.
4.
5.
40 hour internships with a Doctor of Oriental Medicine who is a Diplomate in Oriental Medicine
Family Practice
Pass all oral and written exams.
Complete all correspondence assignment.
Payment
Payment by:
Check
Visa
Master Card
Name as Printed on Card:
Card Number:
Expiration Date:
Authorized Signature: ________________________________________________
Register through:
American Academy of Oriental Family Medical Practitioners
Phone: (870) 772- 8622
Fax:
(870) 779-8477
Mail:
A.A.O.M.F.P
619 East 6th Street
Texarkana, AR, 71854
Email: [email protected]
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
I understand that false or misleading information in my application or interview may result in my release from the program.
All applicants are subject to approval by the American Academy of Oriental Medicine Family Practitioners.
Signature:
Date:
Copyright 2005 Dan Martin D.O.M.
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Four Points Texarkana
Texarkana, TX
 This six-story hotel, on the Texas-Arkansas state line, is within five
miles of major companies.
 Guestrooms feature complimentary ...
More lodging info
Rooms/units may be available
Baymont Inn Texarkana
Texarkana, TX
 Located on the Texas and Arkansas state line, this hotel is 5 miles from
Texarkana Regional Airport.
 Guestrooms feature cable TV, coffee ...
More lodging info
Rooms/units may be available
La Quinta Inn Texarkana
Copyright 2005 Dan Martin D.O.M.
7
Texarkana, AR
 Two miles from downtown Texarkana attractions, this hotel is three
miles from Central Mall and the University of Arkansas.
 Guestrooms offer ...
More lodging info
Rooms/units may be available
Super 8 Texarkana Ar
Texarkana, AR
 This hotel is 5 miles from Lake Bistineau State Park and 3 miles from
Texarkana Regional Airport.
 Guestrooms feature complimentary ...
More lodging info
Rooms/units may be available
Hampton Inn Texarkana Ar
Texarkana, AR
Hampton Inn Texarkana is located at I-30 East or West Exit 223B, in the center of the
4-state area (Arkansas-Texas-Louisiana and Oklahoma). More lodging info
Rooms/units may be available
Best Value Kings Row Inn - Tex
Texarkana, AR
Welcome to the AAA Approved Best Value Kings Row Inn of Texarkana, located on
the Texas/Arkansas state line. We offer our guests 111 beautifully appointed ...
More lodging info
Rooms/units may be available
Comfort Inn Texarkana
Texarkana, TX
Easy access to I-30 and all Texarkana area attractions and events. We offer a FREE
Copyright 2005 Dan Martin D.O.M.
8
Deluxe Continental Breakfast every morning. Whirlpool rooms available as ...
More lodging info
Rooms/units may be available
Econo Lodge Texarkana
Texarkana, TX
FREE wireless high-speed Internet access in all guest rooms and lobby. Located on the
edge of Texas twin city, Arkansas - Texas. More lodging info
Rooms/units may be available
Quality Inn Texarkana
Texarkana, AR
FREE continental breakfast with hot items each morning. Micro/Fridge available.
Quality executive rooms, suites and whirlpool rooms are available. More lodging info
Rooms/units may be available
Copyright 2005 Dan Martin D.O.M.
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