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Urinalysis Samples

Please complete this form when advised to do so. If you require treatment of further investigation you will be contacted within 1 working day.

If you are male and experiencing urinary symptoms please contact the Practice to arrange a telephone consultation.

Urinalysis Samples
Mrs/Miss/Ms/Other
Enter Email
Please use format day/month/year e.g. 12/05/1979

Please answer the following questions

Could you be pregnant ? *
Please use format day/month/year e.g. 12/04/2021
Have you got any vaginal discharge or itch? *
Is this your first episode? *
Have you any pain passing urine? *
Are you passing urine more frequently? *
Do you have blood in your urine? *
Do you have a high temperature? *
Do you have pain in lower tummy or flank/side? *
Do you have a catheter? *
Are you allergic to any Antibiotics? *

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.