UTI Infection Review

We have changed the way we manage urine infections at the practice. If you think you have a urine infection you will be asked to fill in this form and a clinician will call you back within the next 24 hours.

Urine dips are no longer carried out unless there is a clinical need as they are unreliable as a means of testing whether or not you have a urine infection.

Please do not hand in a urine sample unless you get asked to do so.

This form needs to be filled in by all patients who think they may have a urine infection without exceptions. If the patient cannot fill it in then a family member, relative or carer can fill this form in for them. We no longer accept urine samples at the practice without this form being filled in either online or on a paper copy that you can pick up from the practice. You will be texted or called with advice by a nurse / doctor on the same day that you fill in the form.

UTI Infection Review

UTI Infection Review

Your Details

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
Are you enquiring for yourself or on behalf of someone else? *

Their Details

How long have you had symptoms for? *

Please note that the advice for symptoms that are not severe and have occurred for less than 48 hours is to drink plenty and take paracetamol for the discomfort as needed. We do not normally give antibiotics unless symptoms are severe or have occured for more than 48 hours.

Do you have any severe symptoms?
Please tick all that apply.
If none of the above, what symptoms do you have?
Do you think you need antibiotics today or would you be happy to hand in a urine sample to be sent to the laboratory for testing and wait for the result? *
Are you or could you be pregnant? *
Are you on steroids daily or any other medication or treatment which make you more likely to get severe infections? *
Patients with chemotherapy, on methotrexate etc. are more likely to have severe infection.
Do you have more than 3 urine infections a year, or ever been told that your infections are resistant to some antibiotics? *
Have you ever been admitted to hospital for treatment of a urine infection? *
Have you got any allergies or ever had any problems with antibiotics? *
You will be asked about these by the nurse if you have said yes.