UTI

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Personal Details

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This questionnaire from your GP practice will ask you some questions about your symptoms. It should take no longer than 5 minutes to complete.

Do you have any of the following symptoms?: *

How long have you had these symptoms?:

What have you done to manage your symptoms?: *

Have you had a Urinary tract infection (UTI) before, these are sometime called a bladder or water infection?:

Is there a possibility you may be pregnant?:

Do you have a urinary catheter (This is a tube that is inserted into your bladder, which is used to empty the bladder and collect urine) :

Privacy Consent

This form collects personal and medical informanot tion about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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