Anesthesia permits are required before a dental practitioner is permitted to administer Moderate Sedation (Restricted I) or. Must ensure that a patient medical history is taken or updated.• Must give patients a physical evaluation. Complete the sedation request form below for each patient interested in iv-sedation. You can indicate whether they are scheduled or just want more information. Once logged in to your dashboard scroll to the bottom of the page and click on "Apply for New License. (a) Permit required for administration of anesthetic modality in dental office. Dental Office; Caring, Gentle Dentist and Team. Evolve Dental Care in Allentown PA offers Nitrous Oxide Sedation Dentistry. Medical Emergencies in Dental Office.