Forms

Applications

ALL applicants for a Louisiana license (both full as well as restricted) are required to take a jurisprudence examination covering the Louisiana Dental Practice Act which can be found on our website.

APPLICANTS FOR A LICENSE BY CREDENTIALS OR A LICENSE BY AN EXAMINATION IN ANOTHER JURISDICTION: Please contact our office directly to obtain fingerprint cards and forms as they are unavailable from this website.

The following applications are available in Adobe Acrobat Format (*.pdf). Adobe offers a free plug-in viewer on its website.

◦Miscellaneous Publications and Forms
  HIV/HBV/HCV Reporting Form
  Approved Radiology Course List

◦Dental License by Outside Examination
  Dental Outside Exam

◦Dental Hygiene License by Outside Examination
  Hygiene Outside Exam

◦Anesthesia Applications
  Nitrous Oxide Application
  Enteral Conscious Sedation Application
  Parenteral Sedation Application

◦Hygiene Anesthesia
  Hygiene Anesthesia Application
  If you have taken a local anesthesia course outside Louisiana, and wish to apply for a local anesthesia permit, please also fill out the   affidavit below and submit it with your local anesthesia application.
  Local Anesthesia Affidavit

◦Expanded Duty Dental Assistants
  EDDA Application

◦DEA 224 New Application or DEA - 106 Theft or Loss Report
  DEA Forms