Forms & Fees

New - Online Licensing Database - Online Services

The Board's new online licensing database is now online and available for use. Applications, renewal, changes of address and other requests may be made online. Online payment by credit card is now available. You may access the online licensing database here.

Fee Schedule

For information about the fees charged for applications, renewals, reinstatements, verifications and other services follow this link.

Application for License/Registration/Permit

Please note: In order for CPR certification to be accepted for the purposes of initial application (and renewal), the CPR course must include a clinical, "hands-on" portion. Online-only certification courses are not acceptable pursuant to Iowa Administrative Code 650.

Forms

Most of the forms below are in and require Adobe Reader to view. If you do not have Adobe Reader, you can download that software at the Adobe website. Other forms are viewable in your web browser.   

Please note: applications submitted on paper may take longer to process than applications submitted electronically through the online licensing database.

Applications

Title Form Format
Dentists
Dentist Permanent License - By Examination Download PDF
Dentist Permanent License - By Credentials Download PDF
Dentist Resident License Download PDF
Dentist Resident License Extension Download PDF
Dentist Faculty License Download PDF
Dentist General Anesthesia Permit Download PDF
Dentist Moderate Sedation Permit Download PDF
Dentist Temporary Permit - Urgent Need or Education Services Download PDF
Dentist Temporary Permit to provide Volunteer Services Download PDF
Dental Hygienists
Dental Hygienist Permanent License - By Examination Download PDF
Dental Hygienist Permanent License - By Credentials Download PDF
Dental Hygienist Permit for Authorization to Administer Local Anesthesia Download PDF
Dental Hygienist Temporary Permit - Urgent Need or Educational Services Download PDF
Dental Hygienist Temporary Permit to provide Volunteer Services Download PDF
Dental Assistants
Dental Assistant Trainee Status
*Please read application carefully regarding rule change*
Download PDF
Dental Assistant Permanent Registration
*Please read application carefully regarding fee change*
Download PDF
Dental Assistant Radiography Qualification Download PDF
Radiography Qualification Reinstatement Application Download PDF

 

Forms

Title Format
Approved Testing Sites PDF
Change of Address Form Online
Complaint Form PDF
Complaint Form Online
Order Form - Purchase a Data List or Mailing List PDF
Order Form - Purchase a Duplicate Certificate/Renewal Card PDF
Order Form - Purchase a Dental Assistant Trainee Manual PDF
Order Form - Purchase Printed Materials: Iowa Laws & Board Rules PDF
Order Form - Purchase Subscription Services - Board Orders PDF
Order Form - Purchase a Written Verification of License/Registration/Permit PDF
Public Health Supervision Agreement PDF
Public Health Supervision Reporting Form PDF
Sample Lab Prescription and Point of Origin Form PDF
Sign Up for Board Notices via E-Mail PDF
Website Feedback Form Online
Infection Control Inspection Form PDF
IPRC Self-Report Form PDF
Malpractice Report Form PDF

Continuing Education Applications & Forms

Title Format
Approved Sponsor List Online
Prior Approval of a Continuing Education Course PDF
Post Approval of a Continuing Education Course PDF
Prior Approval for Expanded Function Training PDF
Sample Expanded Functions Documentation Form PDF
Sample Continuing Education Record PDF
Sample Continuing Education Record Word
Continuing Education Sponsor Application PDF
Sample Attendance Record Report PDF
Application for Exemption or Extension of Continuing Education Requirements PDF
Application for Inactive Status PDF