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Sole Bay Health Centre NHS GP Surgery in Suffolk

Suspected urinary tract infection (UTI)

What symptoms do you have? (select all that apply) *

Pain on passing urine

Urgency when passing urine

Increased frequency of passing urine

Blood in urine

Dark coloured urine

Itching

Soreness when not passing urine

Discharge from vagina

Back pain

Lower abdominal pain

Upper abdominal pain

Temperature symptoms

Other

Please specify: *

How many days have you had these symptoms? *

Have you had any antibiotics for a UTI in the last 4 weeks? *

Yes

How many times have you been prescribed antibiotics in the last 12 months? *

Are you currently pregnant or breastfeeding? *

Yes

Do you have any known allergies? *

Yes

Please specify: *

Do you have a urinary catheter? *

Yes

If you are human, leave this field blank.

Teal Close
Reydon
Southwold
IP18 6GY

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