Form

Syphilis and chancroid referral form

Form (B3) for the serology and molecular detection of Treponema pallidum.

• From: UK Health Security Agency
• Published: 1 April 2014
• Last updated: 1 August 2023 — See all updates

Documents

B3: Syphilis and chancroid referral form

Ref: GOV-15065

PDF, 695 KB, 1 page

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Details

Send completed forms with samples to:

Bacteriology reference department (BRD)

UK Health Security Agency
61 Colindale Avenue
London
NW9 5EQ

Telephone 020 8327 7887 (staffed from 9am to 5.30pm, Monday to Friday)

DX address UKHSA Colindale Bacteriology, DX 6530002

Specimen submission guidelines can be found in the BRD user manual.

Published 1 April 2014
Last updated 1 August 2023 + show all updates

1. 1 August 2023

   Updated lab referral form.

2. 17 July 2023

   Updated referral form.

3. 6 July 2021

   Updated referral form.

4. 18 February 2015

   Updated form.

5. 1 April 2014

   First published.