Radiologic Health Branch (RHB)

Radiologic Technology and Nuclear Medicine Technology Applications and FAQS

RHB's application forms (below) are categorized as follows:

Radiologic Technologist (RT) Forms
Limited Permit X-ray Technician (XT) Forms
Licentiate Forms (i.e. MD, DO, DC, DPM, PA)
Nuclear Medicine Technologist (NMT) Forms
Miscellaneous Forms: Change of Name/Address - 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. Use form CDPH 8391 (PDF).

IMPORTANT NOTE: If you did not receive your renewal notice, use the "Special Renewal Application" as found in the applicable category below.

General Information or Links:

Radiologic Technologists (RT) Forms

CDPH 8200 (PDF) - Radiologic Technology Certificate Application (Diagnostic & Therapeutic). [DO NOT USE FOR CERTIFICATE RENEWAL]
CDPH 8200 M (PDF) - Mammographic Radiologic Technology Certificate Application [DO NOT USE FOR CERTIFICATE RENEWAL]
Special Renewal Application forms for CRTs only:

CDPH 8200 SRA (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES BEFORE 1/01/15.
CDPH 8200 SRA II (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES FROM 1/01/15 to 8/31/17.
CDPH 8200 SRA III (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES AFTER 8/31/17.

CDPH 8218 (PDF) - Radiologic Technologist Fluoroscopy Permit Application [DO NOT USE FOR PERMIT RENEWAL]
Fluoroscopy Examination Notice (PDF)

Limited Permit X-ray Technician (XT) Forms

CDPH 8232 (PDF) - XT Application [DO NOT USE FOR PERMIT RENEWAL]
CDPH 8232 BD (PDF) - XT Bone Densitometry Permit Application [DO NOT USE FOR PERMIT RENEWAL]
Special Renewal Application forms - XT - Bone Densitometry only.
- CDPH 8232 BD SRA (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES BEFORE 1/01/15.
- CDPH 8232 BD SRA II (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES FROM 1/01/15 to 8/31/17.
- CDPH 8232 BD SRA III (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES AFTER 8/31/17.
Special Renewal Application - XT (Excluding Bone Densitometry)

CDPH 8232 SRA (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES BEFORE 1/01/15.
CDPH 8232 SRA II (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES FROM 1/01/15 to 8/31/17.
CDPH 8232 SRA III (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES AFTER 8/31/17.

CDPH 9054 (PDF) - XT Digital Authorization Application

Licentiate Forms (MD, DO, DC, DPM, PA)

Special Renewal Application forms for Physician Assistant Fluoroscopy Permits:

CDPH 8217 SRA II (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES FROM 1/01/15 to 8/31/17.
CDPH 8217 SRA III (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES AFTER 8/31/17.

CDPH 8230 (PDF) - California Licentiate Supervisor & Operator Permits [DO NOT USE FOR PERMIT RENEWAL]
CDPH 8231 (PDF) - California Radiology S&O Certificate. (For Radiologists ONLY) [DO NOT USE FOR CERTIFICATE RENEWAL]
Special Renewal Application forms -- S&O Certificate or Permit.

CDPH 8238 SRA (PDF)- ONLY USE IF YOUR CERTIFICATE EXPIRES BEFORE 1/01/15.
CDPH 8238 SRA II (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES FROM 1/01/15 to 8/31/17.
CDPH 8238 SRA III (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES AFTER 8/31/17.

CDPH 8711 (PDF) - California Licentiate X-ray Bone Densitometry S&O Permit.
Fluoroscopy Examination Notice (PDF) - Information Notice regarding fluoroscopy study material.
Radiography Radiation Protection Syllabus (PDF) - Provides information on radiation protection in radiologic technology. If you are having difficulty accessing this document, please contact Marilyn.Cantrell@cdph.ca.gov to request this information in an alternate format.

Nuclear Medicine Technologists (NMT) Forms

CDPH 8435 (PDF) - Nuclear Medicine Technology Certificate Application [DO NOT USE FOR PERMIT RENEWAL]
Special Renewal Application forms for Certified Technologist, Nuclear Medicine (CTNM) only:

CDPH 8435 SRA (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES BEFORE 1/01/15.
CDPH 8435 SRA II (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES FROM 1/01/15 to 8/31/17.
CDPH 8435 SRA III (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES AFTER 8/31/17.

Miscellaneous Forms

CDPH 8391 (PDF) - Change of Name or Address Form - RT, XT, NMT, & Licentiates

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Radiologic Health Branch (RHB)

Radiologic Technology and Nuclear Medicine Technology Applications and FAQS

General Information or Links:

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CT-PET Information - Contact rhbschools@cdph.ca.gov.

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Radiologic Technologists (RT) Forms

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Nuclear Medicine Technologists (NMT) Forms

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Radiologic Health Branch (RHB)

Radiologic Technology and Nuclear Medicine Technology Applications and FAQS

General Information or Links:

CT-PET Information - Contact rhbschools@cdph.ca.gov.

Radiologic Technologists (RT) Forms

Limited Permit X-ray Technician (XT) Forms ​​

Licentiate Forms (MD, DO, DC, DPM, PA)

Nuclear Medicine Technologists (NMT) Forms

Miscellaneous Forms

Limited Permit X-ray Technician (XT) Forms