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Board of Dentistry
Forms And Brochures
Where to Mail Forms RDH Restorative Functions Instructor Applications
General Forms Dental Assistant Certification Volunteer License Application
Brochures DA Restorative Functions Malpractice Claim Report
Dental Applications Anesthesia Permits Faculty Applications
Dental Hygiene Applications Cert. of Standing Request
Expanded Practice Permit Information Requests
Where to Mail Forms
You may print and return completed froms to the following address:
 
Forms with Payment: Oregon Board of Dentistry
                                   Unit 23
                                   PO Box 4395
                                   Portland, OR 97208-4395
 
Forms without Payments: Oregon Board of Dentistry
                                          1600 SW 4th Ave., Ste. 770
                                          Portland, OR 97201
 
Please direct any questions or problems downloading these forms to:
Teresa.Haynes@state.or.us or call us at 971-673-3200 during regular business hours.
General Forms

Brochures

Dental Applications
Dental Application Packet - Licensure By Examination
 
This packet is intended for use by those individuals who have taken and passed a clinical examination* within the last five years. This packet contains all the forms needed to apply for licensure in the State of Oregon and is formated to allow for double-sided printing. You will need to contact our office to obtain a fingerprint card. To do so, follow the link below.
 
* Clinical Examination refers to any state or regional exam.

Dental Application Packet - Licensure Without Further Examination
 
This packet is intended for use by those individuals who have taken and passed a clinical examination MORE than five years ago. In addition, you must meet the following requirements to qualify for Licensure Without Further Examination (LWOFE) 
3500 hours of clinical practice in the five years immediatly preceding application
40 hours of continuing education in the immediate two years PRIOR to applying
This packet contains all the forms needed to apply for licensure in the State of Oregon and is formated to allow for double-sided printing. You will need to contact our office to obtain a fingerprint card. To do so, follow the link below.
 

Individual Dental Application Forms
 
Not to be used for license renewal.
To obtain a renewal application please contact the Board Office.
 
Dental Hygiene Applications
Dental Hygiene Application Packet - Licensure By Examination
 
This packet is intended for use by those individuals who have taken  and passed a clinical examination* within the last five years. This packet contains all the forms needed to apply for licensure in the state of Oregon and is formated to allow for double-sided printing. You will need to contact our office to obtain a fingerprint card. To do so, follow the link below.
 
*Clinical Examination refers to any state or regional exam.

Dental Hygiene Application Packet - Licensure Without Further Examination
 
This packet is intended for use by those individuals who have taken and passed a clinical examination MORE than five years ago. In addition, you must meet the following requirements to qualify for Licensure Without Further Examination (LWOFE).
3500 hours of clinical practice in the five years immediately preceding application
24 hours of continuing education in the immediate two years PRIOR to applying.
This packet contains all the forms needed for licensure in the State of Oregon and is formated to allow for double sided printing. You will need to contact our office to obtain a fingerprint card. To do so, follow the link below.

Individual Dental Hygiene Application Forms
Expanded Practice Permit
 
RDH Restorative Functions

Dental Assistant Certification
Certification by Credential
Certification by Credential has two pathways through the Oregon Board of Dentistry:
Pathway 1:
You have a certificate issued by another state that is equivalent to the duties performed in Oregon.
 
Pathway 2:
You have performed the duties for the requested certificate for at least 1,000 hours in the past two years in another state.
If you do not meet one of these two pathways you will have to contact the Dental Assisting National Board (DANB) at 1-800-367-3262, Ext. 451
DA Restorative Functions

Anesthesia Permits
Anesthesia Rules and Educational Requirements
Please review the following information carefully before submitting your anesthesia permit  application.

Anesthesia Permit Applications
 
PLEASE NOTE: All forms must be submitted to the PO BOX Address found on the form.
Cert. of Standing Request
Use this form if you are applying for licensure in another state or jurisdiction and need verification of your Oregon dental or dental hygiene license.
 
PLEASE NOTE: We are unable to accept credit card payments at this time.
Information Requests
 
PLEASE NOTE: We are unable to accept credit card payments at this time.
Instructor Applications

Volunteer License Application

Malpractice Claim Report

Faculty Applications
This section under construction

Page updated: January 11, 2012