Member and Visiting Member Authorization Checklist and 2026

1. Click ‘Get Form’ to open the Member and Visiting Member Authorization Checklist in the editor.
2. Begin by selecting the type of authorization you are seeking: either 'Member Authorization' or 'Visiting Member Authorization'. This will determine the requirements for your application.
3. Fill in your personal details, including your name, dental facility information, and contact details. Ensure accuracy as this information is crucial for processing your application.
4. Indicate which modalities of sedation and/or general anesthesia you intend to administer by checking 'Yes' or 'No' for each option provided.
5. List all drugs you plan to administer for sedation. Be thorough in this section to ensure compliance with regulations.
6. Provide details of your professional training and qualifications, including the institution where you received training and attach any necessary certificates.
7. Complete the attestation section by reading through the statements carefully, signing, and dating the form to confirm your understanding and agreement.
8. Finally, select your payment method and complete that section before submitting your application through our platform.

Start using our platform today to easily fill out your Member and Visiting Member Authorization Checklist for free!