Adverse Occurrence Report


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.)

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)

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

Other Applications

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. Your application shall consist of a completed application itself, a completed Statement of Citizenship, including supporting documentation, a copy of a Self-Query from the National Practitioner Databank and all verification(s) of all current and past licenses.

Board & Committee Meeting Notices, Agendas, Minutes and Audio


Meetings are held at 1740 W. Adams Street, Phoenix, AZ 85007 unless otherwise indicated.  An agenda can be amended up to 24 hours in advance of the scheduled meeting time. After the notice and agenda are posted, you may want to check back within 24 hours of the scheduled to see if the original posting was amended. Both the notice and agenda will read amended in the title if they were amended. Board notices, agendas and minutes will be in Adobe pdf format and will require at least Adobe Acrobat Reader to view. You can get this free software from the Adobe website.

All guests, please sign into each board meeting you attend by using the following web address: or QR Code below:

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If you desire accommodation, such as a sign language interpreter, please contact the Board's office at (602) 242-1492 (TTY 711 for relay service relating to the hearing impaired).  Please make your request as early as possible to allow time to arrange the accommodation.


Audio recordings of the meetings are available as noted below and by written request.

Business Entity Registration Change Form

Other Applications

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.)