Prostate Medication Review

"*" indicates required fields

Prostate medications include Tamsulosin, Alfuzocin and Finasteride.

After submission of this form:

- The practice will continue your medication as usual if you have indicated you are happy with things

- Otherwise the practice will contact you in a few days time days time to arrange a review.

Name*
DD slash MM slash YYYY
eg Dr Turnbull / Dr Brooks

You have been asked to complete this form to let us know whether you think your medication is working.

These medications usually improve urinary symptoms caused by an enlarged prostate but sometimes there is little improvement. We would like to know whether you would like to continue or stop the medication.

Additional information to help with your prostate symptoms can be found here.

INCOMPLETE EMPTYING. Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?*
FREQUENCY. Over the past month, how often have you had to urinate again less than two hours after you finished urinating?*
INTERMITENCY. Over the past month, how often have you found you stopped and started again several times when you urinated?*
URGENCY. Over the last month, how difficult have you found it to postpone urination?*
WEAK STREAM. Over the past month, how often have you had a weak urinary stream?*
STRAINING. Over the past month, how often have you had to push or strain to begin urination?*
NOCTURIA. Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?*

This score can help guide us and yourself on the severity of your prostate symptoms over time.

0-7 : Mild Symptoms
8-19 : Moderate Symptoms
20-35 : Severe Symptoms

How would you like to proceed with your medication?*

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our privacy policy to discover how we protect and manage your submitted data.
Consent*

© 2022 Kristian Turnbull

This field is for validation purposes and should be left unchanged.