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Forms

Please select a category from the dropdown to view related forms and applications.

Please use our Application Wizard for guidance on how to apply for initial licensure as a Dentist.

Please note:  CLINICAL EXAMINATIONS ACCEPTED FOR LICENSURE guidance document 60-25 Policy On Dental Clinical Competency Examination Requirements For Licensure, effective August 5, 2021

Applicants for a Dental license (by Examination or Credential) are accepted exclusively online through our online system.

Instructions for Dental license

Reactivation application for Dentist  – Revised July 2021

Reinstatement application For Dentist – Revised July 2021

Application for a Temporary Dental Permit - Revised July 2021

Form A Dentist

Form B Dentist

Form C Dentist

Please use our Application Wizard for guidance on how to apply for initial licensure as a Dental Hygienist. 

Applicants for a Dental Hygienist license (by Examination or Endorsement) are accepted exclusively online through our online system.

Please note:  CLINICAL EXAMINATIONS ACCEPTED FOR LICENSURE guidance document 60-26 Policy On Dental Hygiene Clinical Competency Examination Requirements For Licensure, effective August 5, 2021.

Instructions for Dental Hygienist license application

Reactivation application for Dental Hygienists – Revised July 2021

Reinstatement application For Dental Hygienist – Revised July 2021

Application for a Temporary Dental Hygiene Permit - Revised July 2021

Form A Dental Hygiene

Form B Dental Hygiene

Form C Dental Hygiene

 

Application for Registration as a Dental Assistant II- Revised February 2022

Reinstatement application for a Dental Assistant II - Revised  July 2021

Reactivation application for a Dental Assistant II  -  Revised  July 2021

Form A Dental Assistant II - Certification of Completion of Dental Assistant Education

Form B Dental Assistant II - Experience Verification

Form C Dental Assistant II - Certification of Authorization to Perform Expanded Duties as a Dental Assistant

Deep Sedation/General Anesthesia

Application for a Permit to Administer Deep Sedation/General Anesthesia – Revised February 2022

Moderate Sedation

NOTICE: The Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students adopted by the American Dental Association in October 2016 detail the current education standards for a moderate sedation course. The October 2016 Guidelines no longer include provisions for a course to administer only by an enteral method. Any moderate sedation course taken on or after November 1, 2016 must meet the October 2016 Guidelines in order for an applicant to qualify for a conscious/moderate sedation permit in Virginia. These Guidelines must be met to qualify to administer by any method and to qualify to administer by an enteral method only. Please download the Guidelines.

Application for a Permit to Administer Moderate Sedation – Revised February 2022

Reinsatement

Reinstatement application for a permit to administer Moderate Sedation and Deep Sedation/General Anesthesia - Revised February 2022

76-24.3 - Inspection report for dental offices, revised April 9, 2021

Pre-Inspection Survey Form - Revised May 2019

 

Dental Lab Work Orders

Dental Laboratory Work Order Form  - Revised Dec. 2012

Dental Laboratory Subcontractor Work Order Form - Revised Dec. 2012

Name/Address Change Form - Revised May 2019

Virginia Board of Dentistry
denbd@dhp.virginia.gov | Contact the Board
Jamie C. Sacksteder, Executive Director
Nathanial C. Bryant, DDS, Board President