Urinary Tract Infection

Urinary Tract Infection Consultation

Are you a female?

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

Have you ever previously been diagnosed with cystitis or a urinary tract infection by a GP or other healthcare professional?

Are you currently experiencing symptoms of a Urinary tract infection?

These symptoms include:
- Burning or stinging sensation when passing urine
- Foul smelling urine
- Needing to urinate more frequently than usual
- Feeling you have the urge to urinate very quickly

Have you had a previous episode of a urinary traction infection in the last 4 weeks?

In the last 12 months have you experienced a urinary tract infection on more than 3 separate occasions?

Have you ever previously had a urinary tract infection which has not been treated successfully by the first course of antibiotics you received?

Have you ever been previously informed that your urinary tract infection is resistant to an antibiotic?

If so, please provide more information

Please provide more details

Are you currently experiencing any of the following symptoms

- Blood in the urine
- Symptoms for over 7 days
- Lower to middle back pain
- Nausea or Vomitting
- Feeling of confusion
- White discharge from the genital area
- Sweet smelling urine
- Feeling short of breath on rest.
- Severe abdominal pain

Have you ever previously been informed that you have any form of Kidney disease or reduced kidney function?

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

Urinary Tract Infection Consultation

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