Urine symptoms for men

If you have been advised by the surgery to submit urine symptoms for men please use this form.

Urine symptoms for men

Urine symptoms for men

About You

Please use this date format: DD/MM/YYYY.

Urinary Tract Review

In the past month:

This will be automatically calculated.

Score:

1 to 7 = Mild

8 to 19 = Moderate

20 to 35 = Severe

Quality of Life Due to Urinary Symptoms:

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