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Form TB and travelling

Form TB and travelling

Registration form TB-check after trip

If you go on holiday to Eastern Europe, Africa, Asia or Central or South America for longer than 3 months, it is wise to contact the Tuberculosis Control Department. If you get the advice to have yourself checked for TB after your trip, please fill in the registration form below. You will receive a written invitation for a TB test within two months of your trip.

Contact

On working days the department can be reached by telephone from 9:30 am to 11:30 am and from 3:00 pm to 4:30 pm via number (020) 555 5240.

(* For a good service it is important for us that you fill in all fields of theĀ form below).

Uw gegevens
Gender (verplicht)
dd-mm-yyyy
Street, house number, zip code and place of residence
dd-mm-yyyy
days/weeks/months
dd-mm-yyyy
Reason for the trip (multiple answers possible) (verplicht)