TB Service North Central London - South Hub online Self Referral form

One of our TB specialists will be in touch with you to arrange a mutually convenient, appropriate appointment.

Website: www.tbnorthcentrallondon.nhs.uk

Please ensure all the fields marked * are filled in correctly.

Patient details
  *First name:
  *Contact Telephone no:
  Email address:
Have you got a GP?
If yes, name and address of your GP

Referral details
Have you been in contact with someone with TB?
Have you been screened for TB before?
Have you had TB before?
If so, where and when was it treated?
Have you had a chest X-ray recently?
If yes, where?
Please explain why you are referring yourself to this service.