Shielding Design Request Form

Please follow the directions below to ensure a timely response to your shielding design request.

1. Please fill out the Shielding Design Request Form below completely. Any missing information will slow down the completion of the shielding design. Note: we must have the legal name AND physical address for the facility.

2. Please attach the following scale drawings (i.e. scale-1/4″=1 foot). Some states will not accept a design without a scale indicator.

a. Room in which the unit will be placed

i. Please be sure to label the position of the radiation equipment, operator barrier, and wall bucky, if applicable.

b. Floor on which the unit is located

i. This drawing must have all surrounding areas on the drawing labeled (e.g. storage closet, corridor, office space, hallway, exterior, bathroom, etc.)

c. Any occupied spaces above and/or below the unit

i. Please ensure all areas above/below the room in which the unit will be placed are highlighted or circled and labeled (e.g. storage, closet, corridor, office space, hallway, exterior, bathroom, etc…).

Your drawing(s) may be attached to this form using the upload area at the bottom, faxed to (770) 599-2333, or emailed to: [email protected]. Please note that the dimensions of a radiographic room must be 8′ x 10′ or greater.

All of the requested information is required to complete a fully customized shielding design, including a scale drawing with a description of the areas surrounding the room; however, we may be able to complete a shielding design based on assumptions if you are unsure about some of the information. A shielding design based on assumptions will be more conservative and may result in the prescription of additional lead, resulting in increased building material costs. 

Our turnaround time is generally 7-10 business days once all the required information has been received by our office. 

Please note, if your request is for a nuclear medicine room, please include a detailed expected patient workload, including all procedures, isotopes, doses, and uptake times. 

If changes are requested after a shielding design is completed, you may incur an additional fee. Please feel free to contact us with any questions.