Free Radical and Radiation Biology Program

IRS Request for Service Updated

PI's name and e-mail address

Researcher's name and e-mail address

Billable MFK

Cancer Center Member Lab

Yes

CCOM Member Lab

Yes

Others

Requested service date and time (working hours 8 am-5 pm)

Second and Third appointment options

Second and Third appointment options
	Second and Third appointment options	Item weight

more items

Please send a few additional appointment options that work for you and your team. This will provide greater flexibility for the lab and help ensure we can accommodate your schedule and needs.

Service Requested

Xstrahl cabinet X-ray

Small animal radiation research platform (SAARP)

FLASH linear accelerator

Other

ACKNOWLEDGE THAT ANIMAL CAGES MUST BE CHANGED.

Yes

Check this box if you require the animal cages changed before your scheduled imaging appointment.

Materials to be irradiated: cells, animals (vertebrate and invertebrate; mice, rats, flies, fish etc), or non-living materials. Include radiation dose to be delivered.

Reagents (if needed)

Do you need whole body or targeted irradiation? If targeted, specify the target for irradiation.

Disclosure

Chemical

Pharmaceutical

Other Hazardous Agent

Other…

Please let us know if your animal has been administered anything.

Disclosure of Chemical, Pharmaceutical, Radioactive, Biological, or Other Hazardous Agents Administered to Animals

Please list the agent that has been administered.

Will any food, treats, or dietary supplements containing experimental compounds or chemicals accompany the animals into the imaging facility?

Yes

If yes, prior approval must be obtained

Agree to notify the imaging core and safety department in advance if any hazardous materials have been used.

Please check this box if you agree to give advance notice to the imaging core and safety department if any hazardous materials have been used.

Barrier? Request for cleaning

Yes

Barrier Facility Training?

Yes

Please confirm that all personnel bringing barrier animals have completed the required barrier facility training.

Request for physics/therapy design support. Initial experimental design and dosimetry services may be requested for radiation delivery methodologies.

I will acknowledge the Radiation and Free Radical Research (RFRR) Core in all scientific publications resulting from its use.