Male Urinary Tract (IPSS)

If you have been advised by the surgery to submit Male Urinary Tract (IPSS) review please use this form.

Only forms submitted in response to a GP request will be accepted

Male Urinary Tract (IPSS)

Male Urinary Tract (IPSS)

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.

Urinary Tract Review

Over the past month, how often does your bladder not feel empty when finished passing urine? *
Over the past month, how often do you need to pass urine within 2 hours of last urinating? *
Over the past month, how often does the flow stop and start when passing urine? *
Over the past month, how often is it hard to delay passing urine? *
Over the past month, how often is the flow poor? *
Over the past month, how often do you need to push or strain to begin? *
Over the past month, how often do you need to pass urine after going to bed? *
If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? *
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