Forms Library

​​​Following are links to all of the forms and checklists available on our website. For further information, please use the links in the left hand navigation or contact the Board office.

Com​plaints

• Complaint and Medical Release Forms
  

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Dentists​

General​

• Verification of Licensure or Registration Form
  
• Notification of Intent to Contract for Continuation of Practice for Incapacitated or Deceased Dentist

Licensure

• Application for Dental Licensure
• Statement Regarding Student Licensure Limitations
• Statement Regarding Faculty Licensure Limitations
  

Retirement/Reinstatement

• Retirement of License Form
  
• Application to Reinstate a Dental License
  
• Affidavit for Active Practice as a Dentist
  
• License Renewal Affidavit for Active Military​
  

Sedation Permits & Facility Certificates

• Application for Sedation or Anesthesia Permit
• Application for Sedation or Anesthesia Facility Certificate
• Sedation or Anesthesia​ Permit Location Notification Form

Specialty Licensure

• Application for Specialty Licensure​​

Charitable Licensure

• Application for Charitable Dental Licensure​
  

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Dental Hygienists

General

• Delegated Duty List
• Verification of Licensure or Registration Form​
  

Licensure

• Application for Dental Hygiene Licensure

Retirement/Reinstatement

• Retirement of License Form
• Application to Reinstate a Dental Hygiene License

Dental Hygiene Registration Applications

• Dental Hygiene Local Anesthesia Registration Application
• General Supervision Application
• Application for Intravenous Access Line Registration
• Application for Laser Debridement Registration
• Public Health Registered Dental Hygienist Application

Charitable Licensure

• Application for Charitable Dental Hygiene Licensure​

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Registered Dental Assistants

• Delegated Duty List​
  
• Radiography Technique Training
  

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Dental Lab Registration

• ​Application for Registration of Dental Laboratories
• Renewal Application for Registration of Dental Laboratories

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Services

• Advisory Opinion Request Form
• Kentucky Dentist List Order Form​
  
• Kentucky Hygienist List Order Form
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