Radiopharm Therapy - Interest Form

Thank you for your interest in the Radiopharmaceutical Therapy accreditation program.
If your facility is interested in applying for Radiopharmaceutical Therapy accreditation, please complete the following form.

Please Note: This is not the application for accreditation. After submitting this interest form, facilities will be contacted with details to begin the accreditation process.
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Facility Name*
Facility Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is your facility currently accredited by IAC in any other modality?*

YesNo
If yes, please enter your current IAC application number(s).*
Please select which area(s) you are currently accredited in by IAC:*

Nuclear CardiologyNuclear MedicinePositron Emission Tomography (PET)Other
Should be Empty:

Thank you for your interest in the Radiopharmaceutical Therapy accreditation program.