Request TBC test Naar de Nederlandse versie van deze pagina Use the form below to make an appointment for a tuberculosis test Fields with a (*) are mandatory Reason for the appointment You can choose "other" if 1 of the first 5 categories isn't applicable. Appointment for:(*) IND screeningGP referralBCG vaccinationCheck up MSTTraveller screening (for an internship outside The Netherlands or a long vacation)Other A reason for the test has not been chosen Are you eligible for an exemption from the compulsory tuberculosis check from the IND?You can check this on the IND's 'Exemption from compulsory tuberculosis list'. If you want to make an appointment for several people at the same time, you must register each person separately. Please also indicate in the comments box at the bottom that you want to make an appointment for several people at the same time. Please use the comment box at the bottom of this form to include the reason you're contacting us. Personal details First name Invalid Input Preposition Last name(*) You haven't filled in your last name Sex(*) FemaleMale You haven't chosen your sex Email address(*) You haven't filled in your email address Phone number(*) You haven't filled in your phone number Birth date(*) You haven't filled in your birth date Birth country(*) You haven't filled in your birth country Nationality(*) You haven't filled in your nationality BSN(*) You haven't filled in a valid BSN Your Burgerservicenummer (BSN) is your own personal number and consists of 9 numbers. Your BSN can be found on your Dutch driver's license, passport or ID card. If you are using a V-number, then please start with a V. Your Burgerservicenummer (BSN) is your own personal number and consists of 9 numbers. Your BSN can be found on your Dutch driver's license, passport or ID card. Date of arrival in The Netherlands(*) You haven't filled your date of arrival in The Netherlands. This date can't be in the future and the format is dd-mm-yyyy. Your date of arrival in The Netherlands needs to be entered as dd-mm-yyyy (day, month, year) and can't be in the future. Address details Street name(*) You haven't filled in a street name House number(*) You haven't filled in your home number Postal code(*) You haven't filled a valid postal code Place of residence(*) You haven't filled in a place of residence Additional details check up MST Name of your function or education course(*) You haven't filled in your your function or education course When do you start at MST?(*) You haven't filled in when you start at MST At which department of MST will you be working?(*) You haven't filled in the department of MST you will be working at How long will you be working at MST?(*) You haven't filled in how long you will be working at MST Have you been vaccinated in the last 6 weeks with the MMR-, yellow fever- and/or typhoid fever vaccine?(*) Yes (opens new field)No You haven't filled in if you've had one of these vaccinations What vaccine did you receive and when?(*) You haven't filled in what vaccines you've received Additional details for traveller screening What countries will you be visiting? How long will you be staying in each country? When do you leave?(*) You haven't filled in what countries you will be visiting Will you be working on location? If yes, in a:(*) NoHospitalShelter for the homeless / drug addictsShelter for the HIV positivePrisonShelter for illegals / refugees You haven't filled in if you'll be working on location Do you use immune system lowering drugs?(*) Yes, corticosteroids (prednison) for more than 4 weeksYes, cancer medicationYes, immune suppressantsNo, none of the above You need to report your drug use Are you suffering from, or have you suffered from?(*) Diabetes MellitusOrgan transplantPsoriaris, colitis ulcerosa or Crohn's DiseaseCancer in the last two yearsSilicosisChronic kidney failure of kidney dialysisAuto immune disease like rheumatism, reumatoide artritisSarcoidosisHIV / AIDSNo, none of the above You haven't filled in your medical history Have you been vaccinated in the last 6 weeks with the MMR-, yellow fever- and/or typhoid fever vaccine?(*) Yes (opens new field)No You haven't filled in if you've had one of these vaccinations What vaccine did you receive and when?(*) You haven't filled in what vaccines you've received Additional details for BCG vaccination Is the result of the heel prick known?(*) Yes (opens new field)No You need to confirm the result of the heel prick What is the result of the heel prick?(*) You need to fill in the result of the heel prick Has your child been born after a pregnancy shorter than 37 weeks?(*) Yes (opens new field)No You need to fill in if the pregnancy was shorter than 37 weeks After how many weeks of pregnancy was your child born?(*) You need to fill in after how many weeks of pregnancy the child was born Has the mother used any medication during pregnancy?(*) Yes (opens new field)No You need to tell if the mother used any medications during pregnancy What medications did the mother use during pregnancy?(*) You need to list the medications the mother used during pregnancy Has the child been to a foreign country or will it go to one in the next six weeks?(*) Yes (opens new field)No You need to tell if there are any countries the child has been to or will go to What countries has the child been to or will go to?(*) List the relevant countries Does your child use any medication?(*) Yes (opens new field)No You need to fill in if your child uses any medication Please list the medication your child uses(*) You need to list the medications your child uses Preferred day and comments Do you have a preference for a specific day? Use the boxes below to choose that day. You can choose multiple days. Mantouxtests (tuberculine skin tests) are only performed on Tuesday and Friday. Preferred day and comments Vaccinations for BCG are only done on Thursdays Preferred day Monday morningMonday afternoonTuesday morningTuesday afternoonThursday morningThursday afternoonFriday morningFriday afternoon Invalid Input Preferred day Monday afternoonTuesday morningThursday morningFriday morning Invalid Input Preferred day Tuesday morningFriday afternoon Invalid Input Comments Invalid Input Costs The chest x-ray for an IND screening test costs € 54,-. These costs need to be paid at the GGD. We prefer you pay by PIN. You can also pay with cash, but it needs to be exact € 54,-. I have read and agree to the text above concerning the cost of a thorax x-ray(*) Yes You need to agree to the text before you can submit the form Submit and privacy Submit GGD Twente processes your personal details in a safe way, according to the applicable rules and laws. See: Privacy (Dutch) (opens new screen). We only use your personal data to process your application: to plan your appointment and register your vaccination. This form is secured by reCAPTCHA. The Google privacy statement and terms of service are applicable to this.