Dental Hygiene Examination Forms

The following material contains those forms used by CITA in the administration of its licensure examinations.  These forms are being provided to assist candidates who might wish to become familiar with their content and usage.  These forms are also provided to candidates, on an as needed basis, during the various stages of CITA’s application and examination process.  These forms are for information purposes only and the forms downloaded from this site are NOT for candidates to bring and use during the examination, with the exception of the Treatment Selection Worksheet and Radiograph/Follow Up Care Forms.

In order to view and/or download the forms, Adobe Acrobat Reader is required.

2015 Application Forms

Pre-Graduate Candidate Application Form
Graduated Hygiene Candidate Application Form
CITA Dental Hygiene Examination Certification Form
Dental Hygiene Facility Fees

2015 Miscellaneous Examination Forms

2015 Exam Preparation and Orientation Form
Interpreter Form
Special Accommodations Form
Limited Liability Form
Examination Appeals/Review Form

Testing Site Facility Information

Guilford Technical Community College Dental Hygiene Program
LSU School of Dentistry
University of Alabama School of Dentistry
UNC School of Dentistry

2014 Dental Hygiene Examination Forms and Grade Sheets

Progress Form
Patient Consent Form
Medical History Form
Treatment Selection Worksheet
Pre-Treatment Evaluation Station Request Form
Post-Treatment Evaluation Station Request Form
Radiograph/Follow Up Care Form