RADIATION MACHINE REGISTRATION FORM NEW REGISTRANTS RH 2261N - cdph ca 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section A: Registrant Information. Fill in the name of your facility, business, or practice, along with the business phone number and type of facility (e.g., dental, medical). Ensure you provide both physical and mailing addresses accurately.
3. Move to Section B: Machine Information. List all radiation machines you possess by entering the manufacturer, model, type code, number of X-ray tubes or electron guns, room name or number, and acquisition date.
4. In Section C: Facility Contact Information, enter the contact person's name, phone number, and email address for any follow-up inquiries from the Radiologic Health Branch.
5. Complete Section D by signing as an authorized representative. Include your name, title/position, signature, and date to confirm that all information is accurate.
6. Finally, review all sections for completeness before submitting. Keep a copy for your records and mail the original form to the specified address provided in Section E.

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