Radioactive Material License Forms

Forms available by downloading (PDF format):

Application for a Radioactive Material License (pdf)

Preceptor Forms (use these forms for new license or when adding new user or new authorization to existing user)

Radiation Safety Officer Preceptor (pdf)

Authorized Medical Physicist Preceptor (pdf)

Authorized Nuclear Pharmacist Perceptor (pdf)

Authorized User Diagnostic Use Preceptor (pdf)

Authorized User Therapy Use Preceptor (pdf)

Authorized User Sealed Source Therapy Use Preceptor (pdf)

Instruction on How to fill-out Preceptor Form (pdf)

Specialty Board(s) Certification Recognized by New Mexico and NRC for MEDICAL USE RADIOACTIVE MATERIAL

Required submittal for licensees undergoing license termination

RCB FORM 014 (Certificate of Disposition) (pdf)

A licensee who is required to pay an annual fee may qualify as a small entity. If a licensee qualifies as a small entity (Part 20.3.16.13) and provides the Department with the proper certification with the annual fee payment, the licensee may pay reduced annual fees.

Small Entity Application

Persons who possess certain generally licensed devices must register with the Bureau using the forms below:

General License Registration Form (pdf)
General License Registration Form Supplemental Sheet(pdf)
Licensee Ownership Transfer Form 2018 cms 10-11-18
)General License Application Small Uranium Thorium Water Filtration System(pdf

For information regarding this page, contact Carl Sullivan of the Bureau at carl.sullivan@state.nm.us.