Reassign a Badge

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Any dosimeters used by individuals are non-transferable. Only unused dosimeters may be transferred. This form should only be used if you have an unused dosimeter in your possession. If you do not have an unused dosimeter in your possession (for the current wear period), a new dosimeter will be issued for the individual being added. For details regarding this request please contact us.

*Clinic Name  
*Primary Contact  
*Clinic Phone Number  

Please indicate the specific unused dosimeter being reassigned below (both name on the dosimeter and the dosimeter number starting with XA or BA located on the back of the dosimeter). Please provide details regarding the individual the dosimeter should be transferred: Name, ID (if applicable), Date of Birth (if applicable). Finally, please confirm in writing that “The dosimeter being transferred has not been used at our facility” before submitting this form. we do not receive written confirmation that the dosimeter was not used, the request will not be processed.