Urinary Tract Infection (UTI)

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Personal Details
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Sex at birth: *
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Checks and declaration

We DO NOT accept submission forms for UTIs if they have been filled in over the weekend (After 5pm on a Friday, a Saturday, or before 5pm on a Sunday).

  • Any that have been filled in will be rejected when we reopen on a Monday.
  • Please only fill this form in on a weekday, or after 5pm on a Sunday.
  • If you feel you have an UTI during the weekend, please contact 111.

We will contact you with any further action needed, including any prescriptions that may have been issued, when your form is reviewed and completed.

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UTI Questions
Are you under the age of 18?: *
Are you a kidney transplant patient?: *
Do you have a catheter?: *
Are you currently pregnant?: *

As you have selected 'YES' on one of the above questions, please drop off a urine sample at our Victoria House Surgery.

Have you had 2 or more UTI's in the past 6 months?: *
Have you had 3 or more UTI's in the past 12 months?: *
Are you breastfeeding?: *
Have you passed any urine in the last 12 hours?: *

Attend A&E

We advise all patients who have not passed any urine in the last 12 hours to attend A&E.

We are unable to offer our patients any further support regarding their suspected UTI if this is the case.

Find your nearest A&E

You cannot continue with this form: *
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Symptoms
Have pain in lower stomach?: *
Have kidney or side pain?: *
Have a temperature?: *
Are you feeling hot or cold?: *
Are you vomiting?: *
Have blood in the urine?: *
Have a burning or stinging sensation?: *
Are you experiencing any itching or soreness in the genital area and/or any discharge?: *
Are you passing urine more at night?: *
Have a urgent need to pee?: *
Is your urine cloudy or foul-smelling?: *
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Care Quality Commission
Rating: Good

Alchester Medical Group
Langford Medical Practice
9 Nightingale Place
Bicester
Oxfordshire
OX26 6XX

Telephone: 01869 248585

Victoria House Surgery
119 Buckingham Road
Bicester
Oxfordshire
OX26 3EU

Telephone: 01869 248585

Minerva Clinial Services (Pharmacy)
Unit 3, The Station House
Heyford Park
Oxfordshire
OX25 5BZ

Telephone: 01869 228822

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