WISCONSIN TUBERCULOSIS RECORD CARD REQUEST
Division of Public Health 
DPH 42013 (10/02) 

Completion of this form is voluntary.  Personally identifiable information collected on this form will be used only to ship Wisconsin TB Skin Test Record Wallet Cards.  

To order the cards, fill in the information below and press the "submit" button.  If you prefer to order by phone, call the TB Program.