Impaction Course – July 2018 – Agreement

Live Patient Hands-On Impaction Course


The WSS Impaction Course is a California Sponsored Free Health Care Event. All participants must read and acknowledge the following statements.


A person who is not licensed to practice dentistry in California but who holds a current, active, and valid license in good standing in another state, district, or territory of the United States to practice dentistry may seek authorization from the Board to provide such health care services at the sponsored event.

Note for California DDS Licensees: A DDS licensed in the State of California may volunteer to provide dental services at a sponsored event if your California license is renewed and current. No further action is required before offering volunteer services.

Application Process and Fees: An out-of-state licensed DDS may request authorization to partwicipate in a sponsored event by submitting to the Board a completed “Request for Authorization to Practice Without a License at a Registered Free Health Care Event,” Form DBC-901-B (Revised 03/2014).

For consumer protection, California law requires out-of-state licensed DDSs to undergo a criminal background check and submit two “classifiable” sets of fingerprints on cards.

Classifiable means that the prints can be “read” by the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI). Fingerprints are more likely to be classifiable if they are taken by a large local law enforcement agency such as a police or sheriff department.

After the fingerprint cards are complete, forward the cards, application, and $79 processing fee to:

Dental Board of California
Attention: J Jackson
2005 Evergreen Street, Suite 1550
Sacramento, CA 95815

Once received at the Board, the fingerprint cards will be forwarded for processing. The average processing time for fingerprint cards is 30 business days.

2. The application, Form DBC-901-B, and fingerprint cards must be submitted to the Dental Board of California as soon as possible to allow time for processing and approval. All course participants acknowledge that their application may not be approved. In the event that an application is not approved, WSS will issue a full refund of course fees.

3. WSS must have your ground address to send finger print cards. This address is a required part of course registration.

4. WSS will attempt to match patients to participating dentists based on each dentist’s training, experience, and expertise. The surgical difficulty of each patient and impaction will vary and WSS cannot guarantee a perfect match.

All dentists must send a copy of their dental license to IVwisdom@aol.com

Cancellation and Refund Policy

Western Surgical and Sedation (WSS) reserves the right to cancel or postpone any course, modify the announced course content, limit enrollment, or change the location, time, date, or speakers due to unforeseen circumstances. Examples of circumstances that could cause course cancellation include; weather, natural disasters, medical conditions, government regulations, facility availability, and dental board restrictions. WSS is not responsible for the refund of any part of the course fee as a result of emergencies, unforeseen circumstances, or events beyond its control. In the event that WSS cancels a program, the registrant will receive a refund or credit toward another continuing education course.

Full refunds will be made when a WSS course is cancelled and is no longer available or a dentist provides documentation proving that they no longer practice dentistry. Western Surgical’s Liability is for the course fee only is not responsible for any other costs incurred.

Attendees who have registered for a course and are unable to attend will receive credit for the next available course provided their space can be filled.

WSS courses may include controversial materials. WSS acknowledges that there is potential risk to participants using limited knowledge when incorporating new techniques and procedures into their practices. WSS assumes no responsibility and cannot be held liable for the clinical diagnosis or treatment of any individual patient.

I have read and agree to the above terms and conditions.