Suspected urinary tract infection

Suspected urinary tract infection

Suspected urinary tract infection

Use this form if you are aged 13 or older and you think that you have a urine infection. We aim to respond within 4 working hours .

For self-help advice see urinary tract infections.

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
Sex: *
This form cannot be used for patients under 13 years of age. Please use the Get Help form.

Background

When did your urine problem start? *
This form cannot be used for such a long standing issue. Please use the
Get Help form.
Have you had 3 or more urine infections in the last month? *
Have you had 2 or more urine infections in the last 6 months? *
Do you have a urinary catheter? *
Are you pregnant? *
Are you allergic to Trimethoprim or Nitrofurantoin? *

Other causes of urine symptoms, apart from urine infection

Do you have unusual discharge from your vagina? *
Do you have unusual discharge from your penis? *
Have you had sex with a new partner in the last 6 months? *
Please complete this form. However, your discharge means that you might have a sexually-transmitted infection. Please contact iCash as soon as possible.

Signs of a kidney infection, or other severe illness

Since your urine problem came on, have you had any of the following?
Due to your above condition we advise you to go to 111.nhs.uk or call 111.

Main signs of a urine infection

Do you have:
Do you have: (only tick the box if this is a new problem)

We have advised you to contact 111. If you choose to submit this form, one of our clinicians will contact you by phone or online message. We will let you know if you need to drop off a urine sample.

After you submit this form, please wait for one of our clinicians to contact you by phone or online message. We will let you know if you need to drop off a urine sample.