Dental Board

Application Forms

Use these forms for a permit to administer enteral (oral), and/or parenteral (IV) and/or deep sedation/general anesthesia.

Use this form to apply for a permit or registration as a non-for-profit entity providing dental services in the State of Missouri pursuant to the provisions of Chapter 332 of the Revised Statutes of Missouri. This goes into effect August 28, 2004.

All non-for-profit entities who register as a Federally Qualified Health Center (FQHC) must have each licensee complete the certification form.

Use this form to comply with the State regulation requiring the report of a patient injury or death to the Board.