Use this service to submit a UTI questionnaire.
If you are a woman aged 16 to 64 years and you are not experiencing any of the following signs: confusion, palpitations, no urine passed in 12 hours, kidney pain, chills, temperature, nausea, or vomiting, please consider contacting your pharmacist for an assessment. Otherwise, please proceed with this questionnaire.
Your responses will help the clinical team assess your symptoms and determine the most appropriate care for you.
You can use this service if you:
- are registered at the surgery
Before you start
We’ll ask you for:
- your first and last name, date of birth, sex, postcode, email and phone number
- if applicable, the details of the person you are completing the form on behalf of
You can also phone us on 0208 888 4142.