COMPLAINT FORM - Online submission to allow anyone the ability to file a complaint against a current Arizona dental licensee.
Address Change Form
ADDRESS CHANGE FORM - Online submission to allow a licensee the ability to update residential, business and/or mailing address(es). Please complete the eight (8) required fields in order to submit your address change form online.
Adverse Occurrence Report
Form used to report any death or incident causing a patient temporary or permanent physical or mental injury occurring in a dental outpatient facility.