New Mexico
Environment Department

Contact Information:
(505) 827-2855 MAIN // 1-800-219-6157 (toll free)
Environmental Emergencies:
505-827-9329 (24 hrs)

Radiation Control Bureau

Medical Imaging & Radiation Therapy Program Application Forms

All applicants, please read the following notice.

Application Forms are below the following notice.

Due to recent developments regarding the spread of COVID-19 (coronavirus), it is strongly encouraged that ALL applications that are submitted to the Medical Imaging & Radiation Therapy Program (MIRTP) be done so Electronically, which will include Electronic Payments for all NM medical imaging and radiation therapy licenses and any of the other related services provided by the MIRTP.

The MIRTP is recommending that ALL application forms and their required supporting documents be submitted Electronically, because ALL NM STATE GOVERNMENT BUILDINGS AND NM LEASED STATE OFFICES ARE NOW CLOSED TO THE PUBLIC.  The Governor has allowed some state employees to work from home.

Therefore, the fastest and perhaps the only way that I will be able to process any medical imaging and radiation therapy licensure requests will be those complete application packets that are SUBMITTED and PAID ELECTRONICALLY.  Also, email may be the only means of communicating with me.

Completed application packets may still be sent by mail; however, NMED internal mail distributions within NMED buildings may be limited, so if you decide to mail your completed application packets, check or money, the processing of your request may be delayed.  NM rules that require an original NM medical imaging and radiation therapy certificates of licensure at each place of employment in NM prior to performing any medical imaging or radiation therapy procedures are still in effect.

Please see the MIRTP web page https://www.env.nm.gov/rcb/mirtp/ for information regarding how to submit your complete application packet ELECTRONICALLY, and how the ELECTRONIC PAYMENT PROCESS works by clicking on the two links are located below all the application forms that appear on the MIRPT WEB PAGE.

License Renewal Application Form for Medical Imaging or Radiation Therapy

Initial Licensure for Medical Imaging or Radiation Therapy Application Form 

Duplicate or Replacement Certificate of Licensure Application Form

 Provisional License Application Form

Temporary Licensure for Medical Imaging or Radiation Therapy Application Form

REQUEST FOR WRITTEN VERIFICATION APPLICATION FORM

LEGAL NAME CHANGE APPLICATION FORM