Mycobacterial Consultation Request

The Mycobacterial Consult Service at National Jewish Health helps practitioners manage drug-resistant tuberculosis and other refractory mycobacterial and respiratory infections.

We cannot do emergent consults. Please complete the form below and we will do our best to respond within seven days. Our physicians donate their time for this free service.

For general referrals and consults, complete the Physician Consultation Request or Physician Referral form.

Other resources: Refer a patient | Order a test | General Physician Consults

Provider Information

What questions do you want answered? *
Type of Consult
Provider First Name *
Provider Last Name *
Provider Phone Number * 
Provider Fax Number  
If out of the United States, International Phone or Fax Number
Provider Email Address * 

Patient Information

Patient First Name *
Patient Last Name *
Patient Phone Number * 
Patient Date of Birth *  
Patient Age  
Patient Gender

DX and brief history *
Current medications used *
Previous medications used *
X-ray/CT scan findings *
Microbiology & Other lab data
Other pertinent info/concerns

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