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Occupational Health

Tuberculin Skin Test (Belleville Location Only) Please read carefully:

We have simplified our online booking and payment for the TB Skin Test.

Please select a future date and appointment time that suits you best to reserve and pay for your appointment!  You must come back 48 hours later to complete each step.

(No refunds on cancellations or missed appointments). PLEASE CHECK YOUR JUNK FOLDER FOR EMAILS

You must complete your Tb skin test PRIOR to receiving a live immunization vaccine such as MMR (measles, mumps, rubella). If not, you must wait 4 weeks before starting Tb skin testing.

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TB Test Appointment

Date:January 19, 2021
Time:12:20pm - 12:30pm

TB Test Appointment

Belleville Location: Tuberculosis Questionnaire

Please complete and submit the registration form below to book your TB Test appointment (No refunds on cancellations or missed appointments). PLEASE CHECK YOUR JUNK MAIL FOLDER FOR EMAILS

PLEASE NOTE: If you complete this form but had problems with completing payment, we are still holding your reservation. Please call/email our office to advise us if you DO or DO NOT require this appointment. Services will be provided at our office. All transactions are in Canadian Currency.

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NOTE: Due to the ongoing Covid-19 pandemic, all payments must be made in advance. NO CASH PAYMENTS will be accepted until this crisis has passed.

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Birthday*
  
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Purpose for TB Screening (please tick one)*

Tuberculin Skin Test Consent

Tuberculin Skin Testing (TST) is administered as an aid in the detection of infection with M. tuberculosis.

If YES to any of the following questions, please contact our office at 613-966-5486 and do not proceed with online booking.

Possible Side Effects:
Side effects are rare. Vesiculation, ulceration or necrosis may appear at the test sit in highly sensitive persons. There have been reports of rare systemic allergic reactions manifested by skin rash within 24 hours. Should these side effects occur, seek immediate medical attention.

Have you had a previous severe reaction (e.g., anaphylaxis, blistering, necrosis or ulceration) to a TB skin test? *
Have you had active TB or treatment in the past?*
Have you ever had a positive reaction to a previous TB skin test which was read by a knowledgeable healthcare worker and documented?*
Within the past month, have you contracted any of the following illnesses: measles, mumps, chicken pox, infectious mononucleosis, typhoid, brucellosis, influenza or whooping cough (pertussis)?
Have you recently had immunization with a live viral vaccine (e.g., MMR -measles/mumps/rubella, varicella vaccines)?

I have read and understood all information provided to me and my questions have been answered to my satisfaction.

I authorize a nurse from Walsh & Associates Occupational Health Services Ltd. to administer TST.

I agree to seek immediate medical attention, if I should develop any health problems following the administration of the TST (such as difficulty breathing, facial swelling, high fever, muscular weakness or hives).

I will return to the Occupational Health Services on the dates provided to me by the Nurse for reading of the TST.*
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