Regulated ProfessionsDentalApplication Forms Application for Licensure - Dental Hygienist Application for Licensure - Dental Specialist Application for Licensure - Dentist Dental Hygiene Permits Verification of Licensure Verification of Specialty Licensure Application for a Permit to Assist the Administration of and Monitor Nitrous Oxide Analgesia Use these forms for a permit to administer enteral (oral), and/or parenteral (IV) and/or deep sedation/general anesthesia. App. for enteral conscious sedation permit App. for enteral conscious sedation site certificate Verification of Completion of a Missouri Dental Board Approved Course form App. for parenteral conscious sedation permit App. for parenteral conscious sedation site certificate Verification of parenteral conscious sedation requirements Affidavit of written protocols for sedation of dental patients App. for deep sedation/general anesthesia permit App. for deep sedation/general anesthesia site certificate Verification of deep sedation/general anesthesia requirements Use this form to apply for a permit or registration as a non-for-profit entity providing dental services in the State of Missouri pursuant to the provisions of Chapter 332 of the Revised Statutes of Missouri. This goes into effect August 28, 2004. Application for permit/registration to provide dental services All non-for-profit entities who register as a Federally Qualified Health Center (FQHC) must have each licensee complete the certification form. Certification of licensee employed by, or contracting with, an FQHC Use this form to comply with the State regulation requiring the report of a patient injury or death to the Board. Patient Injury or Death Reporting Form