Applications & Forms

Applications and forms are PDF files and require Adobe Reader. For best accessibility download the current Adobe Reader.

Applications

• Dentist (PDF)
• Sedation Applications and Forms
  • Sedation Registration (PDF)
  • Moderate Level I (Enteral) (PDF)
  • Moderate Level II (Parenteral) (PDF)
  • Deep Sedation/General Anesthesia (PDF)
  • Itinerant Permit (PDF)
  • 14 Day Notification Form (PDF)
  • Certification Form (PDF)
• Limited Dental License (Retired) (PDF)
• Resident Dentist (PDF)
• Dental Hygienist (PDF)
• Dental Therapist / Provisional Dental Therapist
• Dental Therapy Application (PDF)
• Dental Therapy Practice Agreement Outline (PDF)
• Dental Therapy - Verification of Clinical Practice (PDF)
• Provisional Dental Therapy Application (PDF)
• Provisional Dental Therapy Practice Agreement Outline (PDF)
• Independent Practice Dental Hygienist (PDF)
• Public Health Dental Hygiene Authority
• Public Health Dental Hygiene Authority (PDF)
• Public Health Practice Agreement (PDF)
• Nitrous Oxide Analgesia Authority (PDF)
• Local Anesthesia Authority (PDF)
• Denturist (PDF)
• Denturist Trainee Registration (PDF)
  • Denturist Trainee Supervision Form (PDF)
• Dental Radiographer *APPLY ONLINE*
• Expanded Function Dental Assistant (PDF)
• Faculty License
  • Dentist (PDF)
  • Dental Hygienist
  • Denturist
• Temporary License
  • Dentist (PDF)
  • Dental Hygienist (PDF)

Board Approved Licensure Examinations

• Dentist
• Denturist
• Dental Hygienist and Dental Hygiene Practice Authorities
• Dental Radiography
• Expanded Function Dental Assistant

Forms

• Continuing Education Log (PDF)
• CE Provider Pre-Approval Form (PDF)
• Credit Card Authorization Form (PDF)
• Complaint Form (PDF)
• Complaint Form - Online
• Data Request Form (PDF)

If you cannot find what you are looking for, send an email to the Board of Dental Practice.