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Forms and Applications
Application for Registration of Radiation Services (Docusign)
Form 773 Docusign
Application for Registration of Healing Arts or Veterinary X-Ray Units (DocuSign)
Form 803 DocuSign
Application for Radioactive Material License
Form 844 E
Application for Registration of Ionizing Radiation Device (DocuSign)
Form 1358
Transfer Receipt Record (DocuSign)
Form 1360
Reciprocity Notice of Intent
Form 1043. Required prior to engaging in an activity involving the use of radioactive material (RAM) or x-ray producing machines.
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Mississippi State Department of Health
•
570 East Woodrow Wilson Dr
•
Jackson, MS 39216
•
866‑HLTHY4U
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Contact and information