Printable tb questionnaire 2026

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The document is a TB Screening Questionnaire designed to collect personal information and assess symptoms related to tuberculosis (TB). It includes questions about past TB tests, medical history, and risk factors. The questionnaire also contains a consent section for testing and guidelines for interpreting test results based on induration measurements.

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Click ‘Get Form’ to open the printable TB questionnaire in the editor.
Begin by filling in your personal information at the top of the form, including your first name, last name, middle name, date of birth, and address. Ensure all details are accurate for proper identification.
Next, provide your contact information by entering your home phone, cell or work phone, city, state, and zip code.
Indicate today’s date in the designated field to ensure the form is current.
Circle any symptoms you are experiencing today from the list provided. This helps healthcare professionals assess your condition effectively.
Answer the series of questions regarding your medical history and potential risk factors. Be honest and thorough to ensure accurate evaluation.
Sign and date the consent section at the bottom of the form to acknowledge that you understand the testing process.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to get an appointment for a TB test?

Online appointments: you can book your TB appointment online on the IOM website. if you receive a NULL message, it means the appointment is invalid and you need to rebook. to book an appointment for children aged 10 years and under, you will need to send a copy of their passport to the email address.

Can TB tests be read virtually?

TB Skin Test $40 This is a skin test that is used to check for TB. It requires a follow-up reading, which can be done virtually or curbside, and is included in the price.

Can I book TB test online?

you can book your TB appointment online on the IOM website.

How do I get proof of TB test?

Ask your health care provider for a written record of your positive TB test result. This will be helpful if you are asked to have another TB test in the future.

Can I order my own TB test?

Request A Test works with over 4,000 labs across the United States. Our goal is to make ordering your own TB testing fast and affordable. No need to get a prescription from your doctor or approval from your insurance. Just place your order and go to the lab as soon as youre ready.

tb screening questionnaire

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How can I book my TB test?

In order to book an appointment for UKTB test, please send all necessary prerequisites mentioned below to uktbappointments@iom.int or you can call us at 051-111-466-472 for personalized assistance.

What are the 4 TB screening questions?

Please answer the following questions: Have you ever had a positive TB skin test? Have you ever had close contact with anyone who was sick with TB? Have you ever been vaccinated with BCG? * The significance of the travel exposure should be discussed with a health care provider and evaluated.

What questions do they ask for a TB test?

DATE OF BIRTH Yes No Have you ever had a positive TB skin test or history of active tuberculosis infection? Yes No Has anyone living in your household ever had a history of active tuberculosis? Yes No Have you worked or volunteered in a nursing home, hospital, homeless shelter, prison or other health care facility?