Have you been referred by the Immigration and Naturalization Service (IND) for a tuberculosis test?
Please fill in this form. Please use one form per person. We will contact you as soon as possible to set a date and time.

When filling in and sending this form your data will be saved for 7 days on our server. We save the data to avoid loss in case there are technical problems with the e-mail. By sending this form you agree with this.