Replacement Dosimeter Request

Please note: Use of this online form is the preferred method for submitting a request for a replacement dosimeter badge. Requests submitted via any other method may result in processing delays.

Full Name (as written on BU/BMC ID)*
First Last
BU/BMC ID*
Email*
Replacement needed for:*
- Body dosimeter
- Ring dosimeter
Approximate Date Badge Was Lost:*
MM slash DD slash YYYY
Do you acknowledge that upon receiving your personal dosimeter, per Boston Medical Center – Personnel Radiation Monitoring and Protection Policy, you may not take the dosimeter off BMC property and when the dosimeter is not in use it must be stored in your department’s approved dosimetry rack or other approved location.*
- YES
Phone

This field is for validation purposes and should be left unchanged.

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