Request edit access
X-Ray Inspection Waiver Requests
To seek a waiver to the x-ray inspection requirement, please complete the information below. The Board will be presented with this listing of names for consideration. You must detail what efforts you made to comply with the inspection requirements before being considered for a waiver.
Sign in to Google to save your progress. Learn more
Dentist Name
List the name(s) of any other dentist(s) employed in this office.
Enter the year your x-ray machine inspection is due.
Please describe what efforts you made to obtain an inspection prior to seeking this waiver.
Email Address
Clear form
Never submit passwords through Google Forms.
This form was created inside of State of Wyoming. Report Abuse