Female Patients Form 3

NO, I'VE NOT If YES, please specify:

NO, I'VE NOT If YES I HAVE, please specify:

NO, I'VE NOT If YES I DO, please specify:

NO, I'VE NOT YES, I HAVE - Klebsiella spp. YES, I HAVE - Proteus vulgaris YES, I HAVE - Candida albicans YES, I HAVE - Pseudomonas spp. If YES, please specify:

NO, I'VE NOT If YES I HAVE, please specify:

NO, I'VE NOT If YES I HAVE, please specify:

NO, I'VE NOT If YES I HAVE, please specify:

NO, I'VE NOT If YES I HAVE, please specify:

NO, I'VE NOT YES - LESS THAN THE LAST 2 WEEKS YES - MORE THAN 2 WEEKS AGO If other, please specify:

YES, I HAVE NO, I'M NOT If other, please specify:

Pain, burning or stinging when passing urine Passing urine more than usual at night Cloudy looking urine None of the above

NO, I DON'T If YES I DO, please specify:

NO, I DON'T YES, I DO (calling 111 to get advice about me treatment)

NO YES, I AM

NO, I DON'T YES, I DO

NO, I DON'T If YES, please specify:

NO If YES, please specify:

YES, I CONFIRM