Applications and Forms

* Paper renewal applications are not available online. The Georgia Board of Dentistry strongly encourages licensees to renew online. If you require a paper renewal application, please contact the office of the Georgia Board of Dentistry: (404) 651-8000.

APPLICATIONS ARE VALID FOR ONE YEAR. 

Dentistry - General 

Application for Inactive Status  (PDF, 156.14 KB)  

CE for Volunteer Work Reporting Form  (PDF, 37.82 KB)  

Dental Continuing Education Audit Form  (PDF, 53.94 KB)

Dental License Census Data Form  (PDF, 76.63 KB)

Dental Out of State Verification Form  (PDF, 63 KB)

Dental Reference Form  (PDF, 75.07 KB)  

Dentist Application for Faculty Licensure  (PDF, 317.98 KB)  

Dentist Application for Licensure by Credentials  (PDF, 439.95 KB)  

Dentist Application for Licensure by Endorsement for Military Spouses  (PDF, 374.22 KB)  

Dentist Application for Public Health Licensure  (PDF, 362.08 KB)  

Dentist Application for Reinstatement  (PDF, 404.13 KB)

Dentist Application for Licensure by Exam  (PDF, 336.23 KB)

Duplicate License-License Verification Order Form   (PDF, 216.5 KB)

Jurisprudence Exam and Affidavit Dentist  (PDF, 90.86 KB)

Qualified Alien Status Form  (PDF, 81.29 KB)  

Volunteers in Dentistry and Dental Hygiene Application  (PDF, 307.55 KB)

Dental Hygiene 

Dental Hygiene Census Data Form  (PDF, 64.38 KB)

Application for Inactive Status  (PDF, 156.14 KB)  

CE for Volunteer Work Reporting Form  (PDF, 37.82 KB)  

Dental Hygienist Application for Faculty Licensure  (PDF, 306.31 KB)

Dental Hygienist Application for Licensure by Credentials  (PDF, 329.52 KB)  

Dental Hygienist Application for Licensure by Endorsement for Military Spouses  (PDF, 341.61 KB)

Dental Hygienist Application for Licensure by Exam  (PDF, 334.09 KB)  

Dental Hygienist Application for Reinstatement  (PDF, 409.2 KB)  

Dental Hygienist Online Application Supplement

Duplicate License-License Verification Order Form  (PDF, 216.5 KB)

Jurisprudence Exam and Affidavit Dental Hygienist  (PDF, 90.83 KB)  

Qualified Alien Status Form  (PDF, 81.29 KB)  

Volunteers in Dentistry and Dental Hygiene Application  (PDF, 307.55 KB)

Dentistry - Anesthesia 

Duplicate License-License Verification Order Form  (PDF, 216.5 KB)

Sedation Application for Deep Sedation General Anesthesia Permit  (PDF, 302.14 KB)  

Sedation Application for Moderate Enteral Conscious Sedation Permit  (PDF, 307.29 KB)  

Sedation Application for Moderate Parenteral Conscious Sedation Permit  (PDF, 305.49 KB)  

Sedation Notification of Additional Site-Change in Location  (PDF, 174.73 KB)

Guidelines & Information 

Fee Schedule  (PDF, 84.99 KB)  

Guidelines and Application for Registration of Injectables  (PDF, 151.88 KB)

Guidelines for General Anesthesia-Conscious Sedation Evaluation  (PDF, 146.01 KB)

Guidelines for Practice Closure  (PDF, 135.34 KB)

Secure and Verifiable Documents Under O.C.G.A. 50-36-2  (PDF, 109.49 KB)  

Education Providers

CE Provider Application for IP  (PDF, 57.43 KB)

Request for Review-EDDA Program Form  (PDF, 76.85 KB)

Public Health/ Health Fair

Dental Screening Application  (PDF, 134.66 KB)  

Dentistry - Injectable Pharmaceuticals

Guidelines and Application for Registration of Injectables  (PDF, 151.88 KB)

Board Order Compliance Forms

Monitoring Physician Agreement  (PDF, 68.31 KB)

Quarterly Self-Report Form  (PDF, 84.37 KB)  

Supervising Dentist Agreement  (PDF, 43.5 KB)  

Supervising Dentist Monthly Quarterly Report Form  (PDF, 85.18 KB)  

Board Services, Requests, or Petitions

  File Petition for Rule Variance or Waiver  (PDF, 217.39 KB)

Roster Request Form Dentistry  (PDF, 45.54 KB)  

Wall Certificate Order Form Dentistry  (PDF, 100.21 KB)