Female Urinary Tract Infection (UTI)

If you have been advised by the surgery to submit Female Urinary Tract Infection (UTI) review please use this form.

Female Urinary Tract Infection (UTI)

Female Urinary Tract Infection (UTI)

Section

What is your smoking status? *
Would you like information to help you quit?
Is there a burning / stinging when passing urine? *
Is the urine cloudy, is there any odour? *
Has the urine changed colour? *
Is there any blood in the urine? *
Do you have a fever? *
Do you have vaginal discharge? *
Are you passing urine more often? *
Do you have any of the following? (Please select all that apply)