Anesthesia Evaluations

Description of Program

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.


I. If you are a First Time Applicant for an anesthesia permit you must:

First Apply for a Provisional Anesthesia Permit from the Pennsylvania State Board of Dentistry. This Application can be obtained in one of three ways:

1) Go to the Pennsylvania State Board of Dentistry web site at


b) Under BOARD RESOURCES click on General Board Information

c) Under BOARD FORMS AND RESOURCES click on Initial Applications

d) Under INITIAL APPLICATIONS click on Dentist

e) Select the Anesthesia Permit form for which you are applying

f) Mail the completed application and all the necessary documentation required to the address on the form

2) Contact the Pennsylvania State Board of Dentistry by calling 1-717-783-7162 and request the Provisional Anesthesia Permit Application form for the level you desire.

3) Mail your request for a Provisional Anesthesia Permit Application indicating the level of permit you desire directly to the Pennsylvania State Board of Dentistry at:

State Board of Dentistry

P.O. Box 2649

Harrisburg, PA 17105-2649

II. The State Board of Dentistry will review the application making sure all the documentation requested is included, and they will then send you a Request for A Provisional Permit Form. THIS IS NOT A PROVISIONAL PERMIT.

III. After you have received this form from the State Board of Dentistry you must: Complete the Application for your Anesthesia Office Evaluation. This application can be obtained by either downloading it from the PSOMS website at or by contacting Dr. James L. Robbins either at 215-394-7284 or by email at

IV. After you have completed this additional application from the PSOMS send it with your check to Dr. Robbins to the address listed on the form. You will be then be contacted by the Regional Chair of the Anesthesia Committee of the PSOMS to arrange the date of the Office Anesthesia Evaluation.

V. Once this date has been scheduled, you must record this date on the Request for a Provisional Permit Form that you received previously from the Pennsylvania State Board of Dentistry and return the form to the State Board. DO NOT RETURN THIS FORM TO THE PSOMS.

VI. The State Board will then send Dr. Robbins your Provisional Permit for only that date. PLEASE NOTE!!! YOUR PROVISIONAL PERMIT WILL ONLY BE VALID FOR THE ONE (1) DAY NOTED ON THAT FORM. Please callDr. James L. Robbins at 215-394-7284 to make sure that your provisional permit has been approved before you have your evaluation.

VII. Please call Dr. James L. Robbins with any questions or concerns before your inspection. Do not wait until the last minute!!!!