Get Clearinghouse For Board Actions Self-query Form - Secure Dentalboards

Completing the Clearinghouse For Board Actions Self-Query Form is an essential step for users seeking to understand their professional standing. This guide provides clear instructions to help you efficiently fill out the form online.

Follow the steps to complete the form accurately and efficiently.

1. Click the ‘Get Form’ button to access the self-query form and open it in your selected editor.
2. Fill in the required personal information. This includes your first name, last name, middle name, and any suffix if applicable.
3. Provide any alternative names you have used previously in the appropriate field.
4. Enter your current mailing address, ensuring all details such as street, city, state, and postal code are correct.
5. Add your telephone number for contact purposes.
6. Input your date of birth in the specified format (month/day/year) and your Social Security number.
7. List the professional school you attended, as well as your year of graduation and the degree earned.
8. Indicate your license number and the state in which it was issued.
9. If applicable, include any other state licenses you hold along with their numbers.
10. Provide your DEA number if you have one.
11. Review the completed form for accuracy. All requested information must be provided to process your self-query.
12. Sign the form and include the date of your signature.
13. Have your signature notarized, ensuring that the notary public also signs and adds the expiration date of their commission.
14. Prepare your payment by checking the appropriate method (check/money order or credit card) and provide the required payment details.
15. Mail the completed notarized form and payment to the American Association of Dental Examiners at the provided address.
16. Await the results, which will be mailed back to you within 10 business days from the date of receipt.

Complete your Clearinghouse self-query form online today to ensure your professional standing is up to date.