2024 Renewal Form

To begin your renewal process we need to collect the following information.

  1. Fill out the required information below and submit for review
  2. Upload the following required documents
    • Current CPR Certificate and enter CPR Expiry Date
    • Current Infection Control course that provides a certificate/confirmation of completion.
    • Proof of Personal Comprehensive Liability insurance that starts Feb 1, 2024, and covers to Jan 31, 2025

Once this form and required documents are reviewed by our staff and everything is approved, you will recieve an email with the information on how to pay your renewal fees. This will include instructions on how to pay by check, e-transfer, or credit card.

If there is anything missing that prohibits you from renewing, our staff will send an email to let you know what needs to be provided to approve your renewal.

How to upload your required documents:

  1. Click on My Account
  2. Scroll down to the Additional Information > Document Upload tab
  3. Click "Choose File" under each document upload file.

  1. Navigate to the file you wish to upload.
    • Make sure that the file size is 5 MB or under.
    • You will see the document's title next to the "Choose File" button. If you do not, try to upload the document again.

  1. Scroll down to the bottom of the My Account page and click the "Update Account" button.
    • If you navigate away from the page or forget to click the "Update Account" button, you will not attach the form.
    • Do not refresh the page and wait until the screen displays the message, "Your Account Information Has Successfully Been Submitted."
  2. Please double check that all of your files have been uploaded by navigating back to My Account. Under the "Choose File" button, you should see Current File: View File and Remove File: Trash can icon.

First Name: *
Last Name: *
License Number: *
Renewal Option: *
Full Practice - Renewal
Full Year Non-Practice - Renewal
Payment Options: *
Credit Card
E-Transfer
Check
Are you currently the subject of any investigations, review, disciplinary hearings or proceedings (subject to the profession of Dental Assisting) in any province, territory, state, country or elsewhere?: *
Yes
No
If yes, please explain:
Has any registration, certificate, diploma and/or license entitling you to practice dental assisting in any province, territory, state, country, or elsewhere ever been denied, issued with undertakings, restricted, suspended or cancelled?: *
Yes
No
If yes, please explain:
Have you ever had a finding in the nature of professional misconduct, unskilled practice, incompetence or incapacity or a like finding, made against you in any province, territory, state, country or elsewhere as a dental assistant or in any health profession other than dental assisting?: *
Yes
No
If yes, please explain:
Signature of Applicant: *