Nonionizing Forms

NOTE: Forms are electronically fillable using Adobe Acrobat Reader 8 or higher. To use features such as saving changes to the form and the ability to digitally sign, users should right click to save and open them using Reader and not open them through their web browser (Chrome, Firefox, Edge, etc...). Agency employees are unable to provide technical support on these features.  

Facility Registration Forms
Non-Ionizing Facility Registration (ARRA-NIR) - For Registering New Facilities | Update Exisiting Facility Information | Renew Exisiting Registration
Non-Ionizing Machine Information (ARRA-NIMI) - For Registering Nonionizing Devices (Each Device Being Registered Requires a Seperate Form)
Nonionizing Annual and Registration Fee Schedule
Acknowledgement Forms
LSO Acknowledgement Statement - Form for Laser Safety Officers
RF Acknowledgement Statement
Cosmetic Facility Medical Director Acknowledgement - Form for IPL/Laser Hair Removal and/or Laser Cosmetic Facilities
Medical Director Acknowledgement (Non-Cosmetic) - Form for Medical Facilities (Dental Offices, Hospitals, Medical Offices, Veterinary Offices, Podiatric)
Medical Director Acknowledgement (Chiro) - Form for Chiropractic Offices
Individual/Professional Attestation Forms
Medical Director/Prescribing Official Application/Attestation - Application Form for Medical Director Training and Experience Attestation (MD, DO, NMD, NP)
Health Professional Training Application/Attestation - Application Form for Health Professional Training and Experience Attestation(RN or PA