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What is your biological sex? (at birth)

Date of Birth

Are you aged between 18 - 64?

Yes

Have you previously been diagnosed with a UTI by a health professional?

Yes

Are you requesting medication to treat a current episode of UTI?

Yes

Have you had 2 Urinary Tract Infections in 6 months or 3 in 12 months?

Yes

Have you ever been required to attend hospital due to cystitis spreading to your kidneys?

Yes

Have you been diagnosed with any kidney damage, blood disorders, or folic acid deficiency?

Yes

Do you currently have or previously had within the last month a Sexually transmitted infection (STI)?

Yes

Please select all your symptoms from the following list?

Dysuria (pain, discomfort, burning, tingling with urination)

Increased frequency & urgency

Changes in urine appearance, colour or odour (cloudy, foul smelling)

Nocturia (increased night time urination)

Discomfort or tenderness felt in the lower abdomen

Do you suffer from Diabetes or any Immune system disorders?

Yes

Do you have any other health problems or conditions that you think we should know about?

(e.g. recent or major operations, G6PD, mental illness, neurological conditions, lung conditions etc.

Yes

Are you taking any of the following?

anticoagulants (e.g warfarin) . bone marrow depressants . digoxin . diuretics (e.g. frusemide) . immunosuppressant drugs (e.g. methotrexate, . azathioprine, ciclosporin) . phenytoin . procainamide . pyrimethamine and dapsone . repaglinide . rifampicin . spironolactone

Yes

Do you have any known allergies to any medicine or substances?

Yes

Are you currently pregnant, planning to become pregnant or breastfeeding?

Yes

Is there any other information you feel would be useful for our clinicians to know about?

Yes

Are you aware symptoms should improve within 24 hours and resolve within 3 days of starting treatment? If symptoms do not resolve within 3 days, you should seek medical help from your GP.

Yes

Please acknowledge you are aware that if you experience either back pain or flu like symptoms, you should seek urgent medical advice. For example, call your GP, or NHS 24.

Confirm

I confirm I am over 18 years old. I confirm this treatment is for me, and I consent to this treatment. I will read the patient information leaflet supplied with the medicine specifically the side effects and dosages. I take responsibility to inform my own regular doctor of the online consultation or any changes in my circumstances. I agree to Dr Weightmans terms and conditions.

Yes

To support your care, we kindly ask for your GP details. If treatment is supplied, we may notify them. Providing accurate information helps avoid any delays.

Enter GP details Manually or search via GP postcode/name.

Yes

Assessment

Urinary Tract Infection (UTI) Consultation

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