Business Entity Registration Change Form

Pursuant to A.R.S. § 32-1213(E), business entities are required to notify the Board, in writing, within 30 days, any change to the business entity's name, address, or telephone number; any change in the officers/directors; any change of dentists authorized to provide dental services; and/or the name of the custodian of records.

Online submission (Once all required fields are completed, a "Click to Sign" button will display at the bottom of your screen.)

Restricted Permit to Volunteer, formerly known as: Volunteer Health Services Registration

After some research, it was discovered that the legislative intent for creating the general Volunteer Health Services Registration process was based on the Board's Restricted Permit process. Please be patient as we reconstruct the Restricted Permit application. In the meantime, the Board will continue to receive Volunteer Health Services Registrations to volunteer your dental services at charitable dental clinic or organization. Your application must be submitted by you; no one may submit or attest to its veracity other than you.