Duplicate Registration or Certificate Request

Use the forms below to request the following duplicate certificates:

  • Registered Dental Assistant (RDA) Annual Registration Certificate

  • Nitrous Oxide Monitoring Certificate

  • Pit & Fissure Sealant Certificate

  • Coronal Polishing Certificate

Request Process

  1. Mail the proper duplicate registration or certificate request form to the TSBDE.
  2. Pay required fee based on the number of certificates required.  (See form for current fee.)

Duplicate RDA Annual Registration Certificate Form

Duplicate Nitrous Oxide Monitoring Certificate Request Form

Duplicate Pit & Fissure Sealant Certificate Request Form

Duplicate Coronal Polishing Certificate Request Form