Urinary tract infection assessment

Gender: *

Male

Female

Indeterminate

Do you have painful urination?

Yes

No

Are you passing urine more frequently?

Yes

No

Do you have lower abdominal pain?

Yes

No

Do you have loin or flank pain?

Yes

No

Is there blood seen in your urine?

Yes

No

Could you be pregnant?

Yes

No

N/A

Do you feel unwell?

Yes

No

Are you able to carry out most of your usual activities?

Yes

No

Are you prone to urine infections?

Yes

No

Is your urine cloudy?

Yes

No

Do you have a temperature?

Yes

No

What are your expectations i.e. antibiotics prescribed, appointment with GP etc.?

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