Exhibit 99.5

FORM OF

BENEFICIAL OWNER ELECTION FORM

BIOLASE, INC.

The undersigned acknowledge(s) receipt of your letter and the enclosed materials referred to therein relating to the rights offering by BIOLASE, Inc., a Delaware corporation (the “Company”), of non-transferable subscription rights to purchase units, each such unit comprised of one share of the Company’s Series F Convertible Preferred Stock, $0.001 par value, and 2,500 warrants. Each warrant will be exercisable for one share of the Company’s common stock, $0.001 par value (“Common Stock”).

This will instruct you whether to exercise subscription rights to purchase units distributed with respect to the shares of the Common Stock and/or the June 2020 Warrants held by you for the account of the undersigned, pursuant to the terms and subject to the conditions set forth in the prospectus.

(Check the applicable boxes and provide all required information.)

If you spoke with a broker who solicited such exercise, please indicate the name of the person you spoke with:

I (we) on my (our) own behalf, or on behalf of any person(s) on whose behalf, or under whose directions, I am (we are) signing this form:

Signature:|

Name:

Title:

Address:

Telephone:

Date: _______, 2020