DENTAL HYGIENIST RENEWAL FORM - tsbde texas 2025

1. Click ‘Get Form’ to open the DENTAL HYGIENIST RENEWAL FORM in the editor.
2. Begin by entering your NAME and LICENSE NUMBER in the designated fields at the top of the form.
3. Fill in your LICENSE EXPIRATION DATE. Ensure this is accurate to avoid processing delays.
4. Indicate your current CPR certification status. If you hold a valid certification, provide the issue and expiration dates.
5. Complete the CONTINUING EDUCATION section by checking the appropriate box that reflects your compliance.
6. Address any DISCIPLINARY ACTION questions by selecting the applicable options for both parts 3a and 3b.
7. If applicable, fill out the NAME CHANGE section with how you want it displayed on your new license.
8. Complete the CHANGE OF ADDRESS section if necessary, ensuring all details are correct.
9. Finally, sign and date the form at the bottom, confirming that all information provided is true and accurate.

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