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Applications/Documents


Many South Dakota State Board of Dentistry forms are available in ADOBE .PDF format (Portable Document Format) which is both device and resolution independent. The printed version of these PDF documents will be similar regardless of the device used to print. In order to view, print or download these forms, you must have the free ADOBE Acrobat Reader for Windows, DOS or for Macintosh.

Dentists

    Dentist- Application for New License Download (359 kb PDF)
    Dentist- Application by Credential Verifcation Download (430 kb PDF)
    Dentist- Application to Administer Nitrous Oxide Download (40 kb PDF)
    Dentist- Application to Administer Moderate Sedation Download (148 kb PDF)
    Dentist- Application to Administer General Anesthesia and Deep Sedation Download (106 kb PDF)
    Temporary Volunteer Registration Application Download (90 kb PDF)

Corporations

    Dental Corporation and LLC Application for Registration Download (59 kb PDF)
    Corporate Practice Change in Ownership or Management Download (41 kb PDF)

Dental Hygienists

    Dental Hygienist- Application for New License Download (231 kb PDF)
    Dental Hygienist- Application for Credential License Download (341 kb PDF)
    Dental Hygienist- Application to Administer Nitrous Oxide Download (179 kb PDF)
    Dental Hygienist- Application to Administer Local Anesthesia Download (52 kb PDF)
    Dental Hygienist- Application to Monitor General Anesthesia, Deep Sedation, or Moderate Sedation Download (181 kb PDF)
    Temporary Volunteer Registration Application Download (90 kb PDF)

Registered Dental Assistants

    Registered Dental Assistant- Application for Registration Download (67 kb PDF)
    Registered Dental Assistant- Application to Administer Nitrous Oxide Download (179 kb PDF)
    Registered Dental Assistant- Application to Monitor General, Deep Sedation, or Moderate Sedation Download (49 kb PDF)

Radiographers

    Radiographer- Application for Registration Download (65 kb PDF)

Dental Assistants

    Dental Assistant- Application to Monitor General Anesthesia, Deep Sedation, or Moderate Sedation Download (181 kb PDF)

General

    Collaborative Supervision Agreement Download (122 kb PDF)
    Collaborative Supervision Application Download (86 kb PDF)
    Additional Satellite Office Form Download (32 kb PDF)
    Practitioner List Request Form Download (61 kb PDF)
    Replacement Certificate Request Form Download (30 kb PDF)
    Application for Continuing Education Course Honorarium Download (83 kb PDF)

Sedation/Anesthesia

    Moderate Sedation Permit - List of Approved Courses Download (125 kb PDF)
    Moderate Sedation Permit - Course Approval Request Form Download (358 kb PDF)
    Permit to Monitor General Anesthesia, Deep Sedation or Moderate Sedation - List of Approved Courses Download (92 kb PDF)
    Permit to Monitor General Anesthesia, Deep Sedation or Moderate Sedation - Course Approval Request Form Download (280 kb PDF)
    Practitioner Manual for Office Anesthesia Evaluation Download (263 kb PDF)
    Office Anesthesia Inspection Form Download (187 kb PDF)
    Temporary Permit- Facility Only Inspection Form Download (181 kb PDF)
    Anesthesia Inspector Travel Voucher Download (58 kb PDF)
    Anesthesia Inspector W-9 Form Download (137 kb PDF)
© 2018 South Dakota State Board of Dentistry