Form 6: Application For A Licence To Use Radiation Apparatus - Dental Purposes
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FORM 6: Application for a licence to use radiation apparatus -
Dental Purposes
This application is intended to be used by the majority of persons seeking licences to use radiation
apparatus for dental purposes. If you are unable to complete any aspect of this form using the
selections available within the form, you should complete Form 2 instead.
This form is intended for electronic completion to facilitate fast-tracking of dental use licence
applications. Hand written applications will not be processed via the fast-track route.
Completion Guide:
1.
The application form must be completed in all respects, then printed. It must be signed and
dated before being posted or faxed.
2.
This form is only to be used by registered dental practitioners, dental assistants or students.
3.
The following documents are to be submitted with the application—failure to do this will result
in your application being returned:
(i)
a certified copy of your qualifications, training certificate or evidence of enrolment
(ii)
a certified copy of your proof of identity documents
‘Certified copy’ means a copy of an original document that has been certified by a justice of the peace or a notary
public as being a correct copy of the original document. Copies certified by a Commissioner for Declarations as
defined in Queensland’s Justices of the Peace and Commissioners for Declarations Act 1991 WILL NOT be
accepted.
4.
The correct fee is to be submitted with the application —failure to do this will result in your
application not being accepted.
Note: The application fee is not refundable if this application is not
successful.
How to Submit the Application:
your signed and completed application form, associated documentation (see 3 above)
Please post or fax
and credit card payment form or cheque/money order to:
The Chief Executive
c/- Licensing—Fast Track
Health Protection Branch
Queensland Department of Health
PO Box 2368
FORTITUDE VALLEY BC QLD 4006
or
Facsimile: 07 3328 9622
Note to Applicant:
The Information Privacy Act 2009 sets out the rules for the collection and handling of personal information by the Department of
Health. For information about how the Department of Health protects your personal information, or to learn about your right to access
your own personal information, please see our website at
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