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RHB-Certification Forms

Below are links to all RHB forms for certification and permitting in Radiologic Technology (Medical X-ray) and Nuclear Medicine Technology. The forms are categorized as follows:

  • Radiologic Technologist (RT) Forms
  • Limited Permit X-ray Technician (XT) Forms
  • Licentiate Forms (i.e. MD, DO, DC, DPM)
  • School Forms (RT & XT)
  • Nuclear Medicine Technologist (NMT) Forms
  • Change of Address Form: RT, XT, NMT, & Licentiate.  Important: You are required to inform RHB of any change of name or mailing address within 30 calendar days of the change.
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    If you did not receive your renewal notice, click on certification FAQs below.

    Radiologic Technologist (RT) Forms
    CDPH 8200 (PDF, New Window)
    Radiologic Technology Certificate Application (Diagnostic & Therpeutic). [DO NOT USE FOR CERTIFICATE RENEWAL]
    Radiography Radiation Protection Syllabus (PDF, New Window)
    Provides information on radiation protection in radiologic technology.
    CDPH 8200 M (PDF, New Window)
    Application for a Certificate in Mammographic Radiologic Technology [DO NOT USE FOR CERTIFICATE RENEWAL]
    CDPH 8218 (PDF, New Window)
    Radiologic Technologist Fluoroscopy Permit Application [DO NOT USE FOR PERMIT RENEWAL]
    Fluoroscopy Radiation Protection Syllabus (PDF, New Window)
    Provides information on radiation protection using fluoroscopic X-ray equipment.
    Limited Permit X-ray Technician (XT) Forms
    CDPH 8232 (PDF, New Window)
    X-Ray Technician Limited Permit Application [DO NOT USE FOR PERMIT RENEWAL]
    CDPH 8232 BD (PDF, New Window)
    X-Ray Technician Bone Densitometry Permit Application [DO NOT USE FOR PERMIT RENEWAL]
    CDPH 9054 (Word, New Window)
    X-Ray Technician Digital Authorization Application
    Licentiate Forms (i.e. MD, DO, DC, DPM)
    CDPH 8230 (PDF, New Window)
    California Licentiate Supervisor and Operator Permits [DO NOT USE FOR PERMIT RENEWAL]
    CDPH 8231 (PDF, New Window)
    California Radiology Supervisor and Operator Certificate.[DO NOT USE FOR CERTIFICATE RENEWAL]
    School Forms (RT and XT)
    CDPH 8696 (PDF, New Window)
    Approved School Students Report
    CDPH 8697 (PDF, New Window)
    Report of Change in Information for Approved Schools
    CDPH 8625 (PDF, New Window)
    Accommodation Request
    CDPH 9053 (PDF, New Window)
    Limited Permit Clinical Affiliated Site Request
    Nuclear Medicine Technologist Forms
    CDPH 8435 (PDF, New Window)
    Nuclear Medicine Technology Certificate Application
    Change of Address Form - RT, XT, NMT, and Licentiate
    CDPH 8391 (PDF, New Window)
    Report of Name or Address Change: RT, XT, NMT, and Licentiates.
    Certification FAQs
    Certification FAQs
    Provides answers to frequently asked questions about certificates and permits including special renewal forms for when you fail to receive a renewal notice.