UTI (Urinary Tract Infection) Consultation - PharmaBee UK Online Pharmacy

What is your age?

Under 16

16–17

18–64

What sex were you assigned at birth?

Service is female-only

Female

Male

Please confirm that you understand the following:

User must acknowledge all statements before proceeding

What is your DOB?

Are you experiencing any of the following?

Have you been told by a healthcare professional that you may have:

Screens for pre-existing serious diagnoses

Which symptoms are you currently experiencing?

Captures current UTI symptoms

When did your symptoms start?

Today

1–2 days ago

3–7 days ago

More than 7 days ago

Are your symptoms:

Tracks symptom trajectory

Improving

Staying the same

Getting worse

How would you rate your symptoms?

Severity self-assessment

Mild

Moderate

Severe

Are you experiencing any vaginal symptoms?

Screens for conditions that may mimic UTI

Are you currently pregnant?

Yes

Could you have a sexually transmitted infection (STI)?

STI risk assessment

Yes

Unsure

Have you recently had:

Additional STI risk factors

Are you currently pregnant?

Pregnant users should be excluded from service

Yes

Unsure

Are you trying to become pregnant?

Yes

Are you breastfeeding?

Relevant for prescribing decisions

Yes

Have you had a urinary tract infection before?

Yes

Approximately how many UTIs have you had in the last 12 months?

Frequency of recurrence

3 or more

Unsure

Have you taken antibiotics for a UTI within the last 3 months?

Yes

Did the treatment work?

Efficacy of previous treatment

Yes

Partially

Unsure

Have you ever been diagnosed with any of the following?

Screens for relevant medical conditions

Do you have a urinary catheter?

Catheter users are excluded from service

Yes

Have you ever been told you have G6PD deficiency?

Yes

Unsure

Are you allergic to any medicines?

General allergy check

Yes

Have you previously had an allergic reaction to:

Specific antibiotic allergy screen

Are you currently taking any medicines?

Drug interaction check

Yes

If prescribed antibiotics, are you willing and able to:

Patient commits to safe use of medication Statements (each is a separate checkbox): 1. Take the medicine exactly as instructed 2. Read the patient information leaflet 3. Seek medical advice if symptoms worsen 4. Seek urgent help if red flag symptoms develop 5. Complete the prescribed course unless advised otherwise by a healthcare professional

I confirm that I understand and agree to the above

Is there anything else you would like the prescriber to know?

Open notes for clinician

Do you consent to relevant treatment information being shared with your GP if clinically appropriate?

GP data sharing consent

Yes

Please confirm the following:

Final legal/clinical declarations

1. The information I have provided is accurate and complete.

2. I understand that deliberately providing incorrect information may affect my treatment.

3. I understand that a prescriber may contact me for additional information.

4. I understand that treatment is not guaranteed.

5. I understand that I should seek urgent medical attention if severe symptoms develop.

I confirm that I understand and agree to the above