Llantwit Major & Coastal Vale Medical Practice

Suspected Urinary Tract Infection

Suspected Urinary Tract Infection Online Form

Please only use this form if you are female and aged between 18-65 years old.

Please do not use this form if you are pregnant.


It is important you select as truthfully as possible so we can provide you with the correct advice and treatment.

All fields on this form are mandatory, please complete to the best of your knowledge. By using this form, you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your details.

You will be contacted at some point the same day, please ensure the mobile number you have provided is correct


If you are having symptoms of a UTI and are a women between the age of 18-65 we could treat your symptoms without having to make an appointment! 

Common symptoms of urinary tract infection include:

Strong and frequent urge to urinate

Cloudy, bloody or strong smelling urine

Pain or burning sensation when urinating

Nausea and vomiting

Muscle aches and abdominal pains

We ask you download and complete this Suspected UTI Form, Suspected UTI Patient info page 3, then return it to the surgery with a urine sample before 11.00 AM. 

It is essential you provide us with an up to date contact number as you will be contacted by phone later in the day with your results and any further instructions. 

Please note before leaving the building we will need to check your form as you may be experiencing some symptoms that could require an appointment of which; we will fast-track to the appropriate clinician. 

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