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.

AttachmentSize
Application for Inactive Status Form -- Updated 10/07/14237.66 KB
Affidavit Regarding Citizenship Dentistry - Updated 05/21/15142.79 KB
CE Provider Application for IP - Updated 08/07/1557.16 KB
Continuing Education Audit Form - Updated 09/04/15161.14 KB
CE for Volunteer Work Reporting Form -- Updated 10/07/14128.42 KB
Consent Form for Background Check -- Updated 10/07/1496.93 KB
Dental Application by Exam -Posted 6/29/17776.14 KB
Dental Application for Sedation or Anesthesia Permit -- Posted 11/06/14318.84 KB
Dental Credentials Application - Posted 7/18/17210.16 KB
Dental Faculty License Application – Updated 6/29/17666.9 KB
Dental License Census Data Form - Updated 09/30/1343.08 KB
Dental Out of State Verification Form - Updated 06/21/1363 KB
Dental Public Health Application - Updated 7/18/17146.04 KB
Dental Reference Form -- Updated 10/07/1490.22 KB
Dental Reinstatement Application - Updated 7/18/17180.42 KB
Dental Screening Application -- Updated 10/07/14165.27 KB
Dental Sedation - Notification of Additional Site/Change in Location - Updated 09/21/15142.77 KB
Dental Hygiene Application by Exam - Posted 7/18/17163.78 KB
Dental Hygiene Credentials Application - Updated 7/18/17166.38 KB
Dental Hygiene Census Data Form - Updated 12/09/1364.38 KB
Dental Hygiene Faculty License Application- Updated 7/18/17141.94 KB
Dental Hygiene Online Application Supplement - Posted 7/26/17175.11 KB
Dental Hygiene Reinstatement Application -Updated 7/26/17168.99 KB
Document Submission Cover Sheet -- Updated 10/07/1428.87 KB
Duplicate Dental License-License Verification Order Form - Updated 02/23/16104.67 KB
Fee Schedule - Updated 09/10/13101 KB
Guidelines for General Anesthesia-Conscious Sedation Evaluation Revised - Posted 03/16/15214.77 KB
Guidelines for Practice Closure - Posted 01/27/16135.34 KB
Jurisprudence Dental Examination and Affidavit - Updated 4/21/1792.69 KB
Jurisprudence DH Examination and Affidavit - Updated 4/21/1793.24 KB
Monitoring Physician Agreement -- Updated 10/07/14175.42 KB
Petition for Dental Variance or Waiver -- Updated 10/07/14150.65 KB
Qualified Alien Status - Updated 06/02/14186.35 KB
Quarterly Self Report Form -- Updated 10/07/14226.99 KB
Registration of Injectables -- Posted 3/3/16114.06 KB
Roster Request Form-Dentistry - Posted 03/26/1546.89 KB
Secure and Verifiable Documents Under O.C.G.A. - Posted 11/19/1322.34 KB
Supervising Dentist Agreement13.56 KB
Supervising Dentist Monthly Quarterly Report Form -- Updated 10/07/14219.54 KB
Supervising Dentist Statement -- Updated 10/07/14200.44 KB
Wall Certificate Order Form-Dentistry - Updated 10/07/14139.66 KB
Volunteers in Dentistry Application - Updated 07/18/17113.84 KB