This form is being updated. Please contact the Board's office at 602.242.1492 or [email protected]

Online Order Form for mailing lists and mailing labels

Please file this report if a death, or incident requiring emergency medical response, occurs in a dental office or dental clinic during the administration of or recovery from general anesthesia, deep sedation, moderate sedation, or minimal sedation.

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

Please contact DANB directly at 800.367.3262 or through their website at danb.org/contact-us.

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.

This form is under construction. Please contact Sherrie Biggs at 602.542.4453 or [email protected] 

Please contact DANB directly at 800.367.3262 or through their website at danb.org/contact-us.