QuantiFERON®-TB Gold test request form

Form (N4) for requesting QuantiFERON®-TB Gold test.


QuantiFERON®-TB Gold test referral form (N4)

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Send completed request forms to:

National mycobacterium reference service-South (NMRS-South)

National Infection Service
61 Colindale Avenue


Published 1 April 2014
Last updated 15 December 2017 + show all updates
  1. Updated version of form.
  2. Updated to version 3, October 2016.
  3. First published.