Forms & Documents Library

​​​​​​The following links provide easy access to all of forms, checklists, materials incorporated by reference, and other documents available on our website.

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
• CDC Summary of Infection Prevention Practices in Dental Settings (2016)​
  
• CDC Infection Prevention Checklist for Dent​al Settings (2016)
  
• 2020 American Heart Association Guidelines for CPR and ECC
  

Licensure

• Application for Dental Licensure
• License Renewal Affidavit for Active Military
  
• Affidavit of Active Practice as a Dentist
  
• Statement Regarding Student Licensure Limitations
• Statement Regarding Faculty Licensure Limitations
  

Retirement/Reinstatement

• Retirement of License Form
  
• Application to Reinstate a License​

Sedation Permits & Facility Certificates​

• Application for Sedation or Anesthesia Permit
• Sedation Permit Renewal Application
  
• Application for Sedation or Anesthesia Facility Certificate
• Application for Renewal of Sedation or Anesthesia Facility Certificate​
  
• Sedation or Anesthesia​ Permit Location Notification Form
• ASA Physical Classification System (2020)
  
• ASA Fasting Guidelines for Preoperative Fasting (2017)
  
• ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists (2016)
  
• ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students (2016)​
  

Specialty Licensure

• Application for Specialty Licensure​​​

Charitable Licensure

• Application for Charitable Limited Licensure​​
  

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Dental Hygienists

General

• Delegated Duty List​​
• ​​Verification of Licensure or Registration Form
  
• ​2020 American Heart Association Guidelines for CPR and ECC​
  

Licensure

• Application for Dental Hygiene Licensure
• ​License Renewal Affidavit for Active Military
  

Retirement/Reinstatement

• Retirement of License Form​​
• Application to Reinstate a License​
• Affidavit for Active Practice as a Hygienists
  

Dental Hygiene Registration Applications

• Application for Local Anesthesia Registration
  
• Application for General Supervision Registration​
  
• Application for Intravenous Access Line Registration​
• Application for Laser Debridement Registration
• Application for Public Health Registration
  

Charitable Licensure

• ​Application for Charitable Limited Licensure

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Registered Dental Assistants

• Delegated Duty List​
  
• Radiography Technique Training
  

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Mobile Dentistry

• Application for Registration of Mobile Dental Facility​​
  

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​
• Duplicate License Request Form
  
• Kentucky Dentist List Order Form​
  
• Kentucky Hygienist List Order Form​