Therapy TLD Order Form

University of Wisconsin
Medical Radiation Research Center
Radiation Calibration Laboratory (ADCL)

1111 Highland Avenue, WIMR Rm B1002
Madison, WI 53705-2275
Phone: (608) 262-6320

THERAPY TLD ORDER FORM

This service is used to independently verify the output of a clinical linear accelerator. Patient TLDs are placed on the patient at the site of interest under bolus to provide charged particle equilibrium. Dose-response TLDs are irradiated on a phantom under the same build-up conditions as the patient TLDs.

All TLD's in a set must be returned at the same time.

Each order is shipped via FedEx Priority to arrive by 10:30AM. A $15 shipping fee is included with all orders.

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PO Number

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Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Therapy Patient Monitoring Service: Sets of 3 TLD's ($100.00 each)

Therapy Patient Monitoring Service: Sets of 3 TLD's ($100.00 each)