New Anesthesia Permit Applicants

If you are a first time anesthesia permit applicant please send Dr. Bianchi a copy of the Request for Provisional Approval form you received from the State Board of Dentistry (If you do not have the Request for Provisional Approval, please go to the Anesthesia Evaluations section that you see to the left side of this page). Please include a copy of the check in the amount of $275.00 made payable to the PSOMS – Anesthesia indicating your name and that it is for your initial office evaluation or a copy of the online payment you can do below, which is the fee for your application and evaluation.

Once this date has been scheduled, you must record this date on the Request for a Provisional Approval form that you received previously from the Pennsylvania State Board of Dentistry and return the form to and also upload a scanned copy of the form on the SBOD PALS website. DO NOT RETURN THIS FORM TO THE PSOMS.

The SBOD requires the Executive Director to send a letter with a copy of the completed form confirming the evaluation date.

The State Board will then email Dr. Bianchi your Provisional Permit for only that date. Once he receives the Provisional Anesthesia Permit from the SBOD, it will immediately be emailed to the you. Please call Dr. Michael A. Bianchi at 215-394-7284 at least 2 days before the evaluation if your have not received the 1-day Provisional Anesthesia Permit by that time. PLEASE NOTE!!! YOUR PROVISIONAL ANESTHESIA PERMIT WILL ONLY BE VALID FOR THE ONE (1) DAY NOTED ON THAT FORM.

If you are paying the Anesthesia Fee by check, it should be sent to the following address:

PSOMS – Anesthesia
c/o Christine Corrigan
PO Box 500
Harrisburg, Pa 17108-0500

New Anesthesia Permit Application Fee