Male Urinary Track (IPSS) If you have been advised by the surgery to submit Male Urinary Tract (IPSS) review please use this form. YOUR DETAILSName First Last Date of Birth DD slash MM slash YYYY Contact NumberEmail URINARY TRACT REVIEWHow often does your bladder not feel empty when finished passing urine?Please selectAlmost AlwaysMore than half the timeAbout half the timeLess than half the timeLess than 1 in 5 timesNoneHow often do you need to pass urine within 2 hours of last urinating?Please selectAlmost AlwaysMore than half the timeAbout half the timeLess than half the timeLess than 1 in 5 timesNoneHow often does the flow stop and start when passing urine?Please selectAlmost AlwaysMore than half the timeAbout half the timeLess than half the timeLess than 1 in 5 timesNoneHow often is it hard to delay passing urine?Please selectAlmost AlwaysMore than half the timeAbout half the timeLess than half the timeLess than 1 in 5 timesNoneHow often is the flow poor?Please selectAlmost AlwaysMore than half the timeAbout half the timeLess than half the timeLess than 1 in 5 timesNoneHow often do you need to push or strain to begin?Please selectAlmost AlwaysMore than half the timeAbout half the timeLess than half the timeLess than 1 in 5 timesNoneHow often do you need to pass urine after going to bed?Please selectMore than 44321NoneConsent I consent to the practice collecting and storing my data from this form.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.