Other Applications and Forms

Adverse Occurrence Report

Forms

Form used to report any death or incident causing a patient temporary or permanent physical or mental injury occurring in a dental outpatient facility.

Affiliated Practice

Other Applications

Suggested forms and Instructions for reporting an affiliated practice relation between a Dentist and a Dental Hygienist. 
(Please download, complete the document and submit to [email protected] or mail to 1740 W Adams, Suite 2470 Phoenix, AZ 85007)

Business Registration

Other Applications

Required by any dental business entity, not exclusively owned by a dental licensee, which provides dental services. 
(Please download, complete the document and submit to [email protected] or mail to 1740 W Adams, Suite 2470 Phoenix, AZ 85007)

Dispensing For Profit

Other Applications

Registration and application and instructions for dentists who dispense drugs or devices for profit.

Lists and Labels

Forms

Online Order Form for mailing lists and mailing labels