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Board of Dentistry

Forms And Brochures

Where to Mail Forms

You may print and return completed forms 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

All monies MUST be sent to the PO Box address. If money is sent to the steet address it WILL be returned to you for correct processing and this WILL delay the time it takes to process your request. Please NEVER send cash via US mail. 
  
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.

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General Forms


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Brochures


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Dental Applications

IMPORTANT PAYMENT INFOMATION 

You may combine payment into one cashiers check or money order for application fee payment as long as you make sure you have all applications attached to the cashier check so it is obvious what is being paid for. ​

All monies MUST be sent to the PO Box address. If money is sent to the steet address it WILL be returned to you for correct processing and this WILL delay the time it takes to process your request. Please NEVER send cash via US mail. ​



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 formatted 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 immediately 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 formatted 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
 

 

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Dental Hygiene Applications

IMPORTANT PAYMENT INFOMATION 

You may combine payment into one cashiers check or money order for application fee payment as long as you make sure you have all applications attached to the cashier check so it is obvious what is being paid for. ​

All monies MUST be sent to the PO Box address. If money is sent to the steet address it WILL be returned to you for correct processing and this WILL delay the time it takes to process your request. Please NEVER send cash via US mail. ​



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 formatted 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 formatted 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

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​Expanded Practice Permit

  
All monies MUST be sent to the PO Box address. If money is sent to the steet address it WILL be returned to you for correct processing and this WILL delay the time it takes to process your request. Please NEVER send cash via US mail. ​

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RDH Restorative Functions


All monies MUST be sent to the PO Box address. If money is sent to the steet address it WILL be returned to you for correct processing and this WILL delay the time it takes to process your request. Please NEVER send cash via US mail. ​
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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
​
All monies MUST be sent to the PO Box address. If money is sent to the steet address it WILL be returned to you for correct processing and this WILL delay the time it takes to process your request. Please NEVER send cash via US mail. ​
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DA Restorative Functions


All monies MUST be sent to the PO Box address. If money is sent to the steet address it WILL be returned to you for correct processing and this WILL delay the time it takes to process your request. Please NEVER send cash via US mail. ​
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Anesthesia Permits

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

Anesthesia Permit Applications
 
All monies MUST be sent to the PO Box address. If money is sent to the steet address it WILL be returned to you for correct processing and this WILL delay the time it takes to process your request. Please NEVER send cash via US mail.  

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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. 

All monies MUST be sent to the PO Box address. If money is sent to the steet address it WILL be returned to you for correct processing and this WILL delay the time it takes to process your request. Please NEVER send cash via US mail. ​
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Information Requests

 
PLEASE NOTE: We are unable to accept credit card payments at this time.

All monies MUST be sent to the PO Box address. If money is sent to the steet address it WILL be returned to you for correct processing and this WILL delay the time it takes to process your request. Please NEVER send cash via US mail. ​
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Instructor Applications

All monies MUST be sent to the PO Box address. If money is sent to the steet address it WILL be returned to you for correct processing and this WILL delay the time it takes to process your request. Please NEVER send cash via US mail. ​
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Volunteer License Application


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Malpractice Claim Report


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Faculty Applications


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