New Anesthesia Permit Applicants

Description of Program & Protocol for New Anesthesia Permit Applicants


The In Office Anesthesia Evaluation Program established by the PSOMS has been providing anesthesia evaluation services for the Pennsylvania State Board of Dentistry since 2004. The program’s primary purpose is to evaluate candidates interested in obtaining an anesthesia permit that allows them to provide anesthesia services to patients undergoing in-office dental and surgical treatment. The program is designed to allow a candidate to demonstrate, in real time in front of evaluators highly trained in anesthesia care, their didactic knowledge and clinical skills by providing anesthesia care to a patient undergoing dental treatment. The program also evaluates the facility in which the anesthesia services are provided to ensure that all systems, ancillary equipment, monitors, supplies, medications, protocols and anesthesia care team involved with providing anesthesia services are the safest, most up to date and demonstrate a high standard of care.

If you are a first time anesthesia permit applicant, please follow the below instructions.

  1. Go to the Pennsylvania State Board of Dentistry web site at (PALS) at Click on Login to Your Account (User Name and Password is the same as for your dental license) and access your dashboard. Once logged in to your dashboard scroll to the bottom of the page and click on “Apply for New License.” Select the State Board of Dentistry and the Permit Type (Anesthesia Unrestricted or Anesthesia Restricted 1) to start the application process. If you have any questions or need assistance with the application process, you can contact the State Board of Dentistry at 717-783-7162.
  2. Please email Dr. Bianchi (Executive Director) a blank, unsigned copy of the “Request for Provisional Approval” form you received from the State Board of Dentistry. This indicates you have started the process with the state board. THIS IS NOT THE 1 DAY PROVISIONAL ANESTHESIA PERMIT. His email address is Please note: we do not accept paperwork from anyone besides the permit holder or prospective permit holders themselves. We kindly ask the applicant to submit his or her own paperwork for processing.
  3. Once the blank forms are received, the applicant will be instructed to fill out our application. To access the application page, the applicant must first pay online via the link below. By paying on the website, it will ask you to create a username and password. This login will be used to gain access to the application page.
    1. If you are unable to pay online, then a check may be sent. If you send a check, the original check should be mailed to: Christine Corrigan PSOMS PO Box 500 Harrisburg, PA 17108 – 0500. Please also email a scan or a photo of the check in the amount of $275.00 that you made payable to the PSOMS – Anesthesia indicating your name to Once a copy of the check has been received, we will create you a login for the website where you may access the application forms.
  4. The application forms can be found under First Time Applicants >> Application Forms. There are four necessary forms to fill out. The file will 37 pages long; however, please ONLY email the 4 necessary forms (pages 7-10) signed and witnessed where indicated as a SINGLE PDF file. In any other format, the applicant will be asked to resubmit and this will delay the process. Additionally, we will only process applications from permit holders. Applications sent by auxiliary staff members will not be processed.
  5. Once your application is approved, Dr. Bianchi will indicate when your forms have been sent to your respective regional director for scheduling.  The regional director will contact you to set up the date. Please be patient. This process will take several weeks.
  6. Once the 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 as a PDF to and also upload a scanned copy of the form on the SBOD PALS website. DO NOT RETURN THIS FORM TO THE PSOMS OR THE SBOD.
  7. The Executive Director will send a letter along with a copy of your completed form confirming your evaluation date.
  8. The SBOD will send back your provisional permit to the Executive Director, who will forward it to you.  Please note this portion of the process can take 7-10 business days.
  9. Make sure the 1 Day Provisional Anesthesia Permit is part of the information that is given to the office anesthesia evaluators on the day of the evaluation.

If you have have questions or have not receive your permit at least 3 days before your evaluation, please email Dr. Michael A. Bianchi, Executive Director, at

PLEASE NOTE: Your provisional anesthesia permit will only be valid for the ONE (1) date noted on that form.

New Anesthesia Permit Application Fee