Cosmetic Laser

NEW COSMETIC LASER REGISTRANTS OR FACILITIES WITH CHANGE OF OWNERSHIP

Complete:

• Non-Ionizing Facility Registration (ARRA-NIR) to register facility
• Non-Ionizing Machine Information (ARRA-NIMI) - Nonionizing Machine Make and Model Information
  for EACH laser unit you are going to utilize
• Provide a Medical Director Cosmetic Facility Medical Director Acknowledgement
• Complete a Medical Director/Prescribing Official Application/Attestation for each Medical Director.
• Provide a copy of the Licensed Practitioner’s current Arizona Medical Board License
• Provide a Laser Safety Officer LSO Acknowledgement Statement
• Written explanation of intended use of the laser(s)
• Send in fee**
• Certified Operators must post an original certification at thier place of employment

*Certified Laser Operators must currently meet A.A.C. Requirements-R12-1-1438.01 (est. Page 225) andA.R.S. §32-3233 and A.R.S. §32-516. 
**Fees will be $47.00 for each Laser head device.

You will need to provide all the above to complete the process of your application. Do not leave any blank spaces, incomplete forms will be returned.

CURRENT REGISTRANTS THAT WANT TO RENEW, CHANGE FACILITY NAME, OR CHANGE ADDRESS

Complete:

• Non-Ionizing Facility Registration (ARRA NIR) to register facility
• No fee***

CURRENT REGISTRANTS THAT WANT TO MAKE AN AMENDMENT TO THEIR REGISTRATIONS, (ADD/REMOVE UNITS, OR CHANGE OF MEDICAL DIRECTOR OR LSO)

Complete:

• Non-Ionizing Machine Information (ARRA-NIMI) - Nonionizing machine Make and Model Information
  for EACH laser unit you are going to utilize
• No fee***

If change in Medical Director and/or LSO, please also submit the following:

• Provide a Medical Director Cosmetic Facility Medical Director Acknowledgement
• Complete a Medical Director/Prescribing Official Application/Attestation for each Medical Director.
• Provide a Laser Safety Officer LSO Acknowledgement Statement