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07425 899611

Cystitis UTI Consultation

Cystitis UTI is an inflammation of the bladder which is normally caused by an infection on the bladder. It's a common kind of urinary tract infection (UTI), mostly in women. Although it's not a serious condition, it can cause a lot of discomforts.

1. About your Health

To help us understand that this treatment is the right option for you, please answer the following questions.

0%

Please state your gender

This refers to your biological gender

Male

Female

What is your date of birth?

Use the calendar to select your date of birth.

Please add your height (in cms)

Your height is important for the prescribers decision.

Please add your current weight (in kgs)

Please make sure to add your current weight. This may affect the prescriber's decision.

Do you have any recent or past medical history of note?

If so, please provide more information

Yes

No

Do you suffer from any allergies?

If so, please provide more information

Yes

No

Do you currently take any medication whatsoever?

Please list all your current prescription medication including any medication you buy over the counter.

Yes

No

Is there a history of medical disorder's within your family?

If so, please provide more information

Yes

No

Are there any other health/medical details you feel we should know?

If so, please provide more information

Yes

No

2. About your Condition

To help us understand that this treatment is the right option for you, please answer the following questions.

0%

Is this a repeat prescription?

Yes

No

Were you assigned female at birth?

Yes

No

Are you pregnant or breastfeeding?

Yes

No

If you are having periods, have you missed your last one?

Yes

No

Have you developed a new vaginal discharge in the last week?

Yes

No

Do you have a catheter ( a thin plastic tube) inserted into the bladder?

Yes

No

Has your infection followed an operation or other surgical procedure?

Yes

No

Have you had antibiotics for a urine infection in the last six months?

Yes

No

Do you have at least two of the following symptoms?

Discomfort, stinging or burning when you pass urine
Cloudy urine
An increase in the number of times you need to pass urine at night?

Yes

No

Have you seen blood when you have been for a pee?

Yes

No

Do you have any of the following symptoms?

Back pain
Temperature above 38degC
Feeling very unwell
Nausea and vomiting

Yes

No

Do you have any of the following conditions

- Acute porphyria

- Kidney Disease

- Liver Disease

- Pulmonary Fibrosis

- Peripheral Neuropathy

- Glucose-6-Phosphate Deficiency

Yes

No

Have you had an allergic reaction to Nitrofurantoin?

Yes

No

Are you taking either of the following medications?

Dapsone
Prilocaine

Yes

No

I understand that urinary tract symptoms can settle without antibiotics and I should wait for 48 hours after my symptoms have started before starting antibiotics.

Yes

No

I will seek medical advice from my GP or 111 if:

My symptoms do not improve within 48 hours of starting antibiotics
My symptoms are worsening despite having started antibiotics
I am unwell, for example I have a high fever, vomiting, back pain

Yes

No

I will seek medical advice from my GP or 111 if my symptoms return on finishing a course of antibiotic

Yes

No

I understand that to help my symptoms, I need to ensure I am drinking water to avoid dehydration

Yes

No

I can take paracetamol or ibuprofen to help with discomfort should I need it.

Yes

No

Is there anything else which you feel we should know about prior to you taking this medication?

Yes

No

3. The Agreement and Consent

Please answer the following questions to help us confirm that you'll follow the guidelines for this medicine.

0%

Do you agree to the following?

You will read the patient information leaflet supplied with your medication
You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
The treatment is solely for your own use
You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.

Yes

No

I agree to the Terms and Conditions and I confirm that I am over 18.
Terms and Conditions

Yes

No

About Us

Profarma Direct is a cutting-edge online pharmacy that specialises in lifestyle medicine and personalised prescriptions.

Marsh House Lane, Darwen, Lancashire, BB3 3JB, United Kingdom
07425 899611
For Sales & Orders:
info@profarmadirect.com
For General Enquiry:
info@profarmadirect.com

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How to check GPhC Registration

You can check our pharmacy details and registration status here. You can also see details of any Fitness to Practise decisions relating to a registrant.

GPhC Registration Number:

2076639

GPhC Registered Owner:

Profarma Direct Ltd

Superintendent Pharmacist:

Zakaria Jalgaonkar

GPhC Pharmacy Details:

Marsh House Lane, Darwen, Lancashire, BB3 3JB, United Kingdom

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