Public Pricelist

♀ Patient - Cystitis and UTI Treatment

Page 1 of 2

STEP 1 OF 2

Describe your symptoms (especially, bladder, kidney/genitourinary conditions) *

Did this problem occur gradually or all of a sudden?

Have you any history of frequent infections? *

Do you have Hematuria (blood in your urine)? *

Do you have an indwelling catheter? *

Have you had a Urine culture? *

Have you ever been diagnosed as immunosuppressed with the following infection? *

Do you have any abnormality of the renal tract (eg: blockage)? *

Any episodes of incomplete bladder emptying? *

Other than issues already mentioned, do you have any other significant medical conditions, illnesses or past surgical procedures? *

Have you resently been prescribed an Antibiotic? *

Have you been - Sexually active? *

Have you a new sexual partner? *

Any other medical information relevant to your treatment request that you think our Doctor should consider?