Irritable Bowel Syndrome

Irritable Bowel Syndrome Consultation

Are you a female?

What is your D.O.B (dd/mm/yyyy)

Have you ever previously been diagnosed with Irritable Bowel Syndrome by your GP or any other healthcare professional?

Are you currently suffering with BOTH of the following symptoms?

- Abdominal pain - Stomach spasms

Are the symptoms you are experiencing worse after eating?

Are you currently experiencing any of the below symptoms?

- Unusual tiredness - Nausea - Back pain - Severe constipation (no stools passed in over 48 hours) - Diarrhoea lasting longer than 2 days - Headaches that seem to be linked to your symptoms - Increased need to urinate - Any pain when urinating - Blood in the urine or stools - Any unexplained weight loss

How long have you been experiencing your current symptoms?

Under 1 month

Over 3 months

1 to 3 months

Have you ever previously been diagnosed with any other medical conditions?

This includes conditions such as - Asthma - Kidney disease - Liver disease - Eczema

Please provide more details

Do you suffer with any allergies?

If so, please provide more information

Please provide more details

Do you currently take any medication? This includes herbal remedies and over the counter medication.

If so, please provide more information

Please provide more details

Are you pregnant, planning a pregnancy or breast-feeding at the moment?

Is there any other information you would like to share with our prescribing team?

If so, please provide more information

Please provide more details

We strongly recommend that you inform your GP of any treatment you receive. Would you like WePrescribe to do this on your behalf?

I have read and understood the Terms and Conditions.

Please see our terms and conditions here

Irritable Bowel Syndrome Consultation

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