Forms and Publications

Educational Programs

DHBC Extramural Facility Permit Application

Continuing Education Audit Forms

Continuing Education Summary

Applications

Applications for Initial Licensure
CA RDH Program Director Certification Form
Certification of Dental Hygiene Clinical Practice (Required for Licensure By Credential and RDHAP Applicants)
CRDTS Application
Licensure By Clinical Exam Application Checklist
Out of State Licensure Certification
Practice Dental Hygiene through Licensure by Credential
Practice Dental Hygiene through Licensure by Credential Checklist
Registered Dental Hygiene through Western Regional Examination Board
Registered Dental Hygienist in Alternative Practice
Request for Special Accommodations for taking Written Examination
National Board Dental Hygiene Scorecard Request
Request for Hard Fingerprints Cards
Certifications of California Licensure
Request for Certification of California RDH License
Request for Certification of California RDHAP License
Request for Certification of California RDA License
Fictitious Name Permit and Mobile Dental Hygiene Clinic (for RDHAP's)
FNP Application Information
FNP Application and Requirements
Application for Registration of Mobile Dental Hygiene Clinic
RDHAP (required) – Register of Practice or Portable Equipment
Register Place of Practice or Portable Equipment Application
Licensee Forms
Request for Hard Fingerprints Cards
Address/Name Change
Name and Gender Change Notification and Request for Confidentiality (SB 372, 2023)
Effective January 1, 2024, under Business and Professions Code section 27.5, licensees may notify the licensing board or bureau within the Department of Consumer Affairs (DCA) of a name and/or gender change and request confidentiality of the previous name or gender information, when meeting certain specified requirements. For more information and to make a request, click here.
Activate/Inactivate License
Retired Licensure
Reactivation of a Retired License
Documentation of Registered Dental Hygienist in Alternative Practice Relationship with Dentist
Please contact us for Live Scan forms, specify license type in the request.
Request for Duplicate/Replacement License
Courtesy Form for Reporting Dental Patient Death or Hospitalization
Miscellaneous Applications and Forms
Dental Hygiene Program Complaint Form
Application for Certification of Out–of–State Dental Hygiene Education in Soft Tissue Curettage, Local Anesthesia, And Nitrous Oxide–Oxygen Analgesia
Dental Hygiene Practice under Military Orders – HR 7939
Remedial Education Course Application

Publications