Forms & Documents Library

​​​​​​​The following links provide easy access to the forms and resources available on our website.

Licensure Forms

• Application for Dental Licensure
• ​​Application for Dental Hygiene Licensure
  
• Application for Charitable Limited Licensure
  
• ​Application for Specialty Dental Licensure
  
• Affidavit of Active Practice as a Dentist or Dental Hygienist
  
• Statement Regarding Student Licensure Limitations
• Statement Regarding Faculty Licensure Limitations​​​

Retirement/Reinstatement Forms

• Retirement of License Form
  
• Application to Reinstate a License
  
• ​Affidavit of Active Practice as a Dentist or Dental Hygienist
  

Sedation Permit & ​Facility Certificate Forms​​

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

​Special Requests​ & Services Forms

• Verification of Licensure Form
  
• Advisory Opinion Request Form​
• Duplicate License Request Form
  
• Kentucky Dentist List Order Form​
  
• Kentucky Hygienist List Order Form

• Complaint and Medical Release Forms