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Clinics & Services
Services
Alcohol Withdrawal Symptoms
Alcohol & Drug Services
Advocacy Service
Cervical Screening
Dementia Services
Diabetes Services
Housebound & Older People
Interpreting Service
New Medicine Service (NMS)
Non NHS Services
Frailty Initiative
Occupational Therapy (O.T)
Pharmacy First
Practice Dispensary Service
Patient Transport Service
Start using GP online Services
Screening Services
Services for Carers
Stop Smoking Service
Domestic Violence
Referral for Further Care
NHS e-Referral Tracking
Referral to Hospital by your GP
Average Referral Waiting Times – Outpatient
Clinics
Long Term Conditions
Annual Health Check
Contraceptive Advice
Your Contraception Guide
Child Health Checks
NHS Health Check aged 40 – 74
Weight Management
Flu Vaccination Clinic
Antenatal Care
Our Clinics
Managing Your Health
Appointments
Cancel an Appointment
Book an Appointment
Get Immediate Help from Your Pharmacist
Get Immediate Help for Minor Injuries
Help with your Appointment
Diarrhoea and Vomiting – Dos and Don’ts
Managing Your Infection
More about Sprains and Strains
Monitored Dosage System
Register with us as a New Patient
Temporary Services
GP2GP
Registration Policy
Know Who to Turn to for Your Healthcare
Dentist
Optician
Hospitals
NHS Out of Hours Services
Accident & Emergency
Pharmacist
Ordering your Medication
Electronic Prescriptions
Get a Sick or Fit Note
Home Visits
Access your Test Results
Request by Patients for Hepatitis B Immunisation
Consult with a Doctor or Healthcare Professional
X-Ray?
Health Review Forms
Alcohol Consumption Review Form
Asthma Review Form
Blood Pressure Review Form
Breathlessness Review Form
Epilepsy Review Form
Male Urinary Tract (IPSS) Review Form
Mental Health Review (PHQ-9) Form
Smoking Review Form
Travel Risk Assessment Form
What is a Blood Test?
Update your Personal Details Forms
Change of Contact Details Form
Register as a Carer Form
SystmOne Online Application
Communication Consent Form
Antibiotic Awareness
Help & Support
Care & Support
Cancer Support Services
Health Unlocked
Together for Short Lives
The Brain Tumour Charity
Age UK
Orchid – Fighting Male Cancer
Are you a Carer ?
Bereavement
Organ Donation
End of Life Care
End of life care
Together for short Lives
Children’s Health
Triple P – Positive Parenting Programme
Change4Life
Your Guide to Coughs, Colds, Earache & Sore Throats for your Child.
Childline
Disability
Contact – For Families with Disabled Children
Vision Impairment
Deaf or Hard of Hearing
Learning Disability
Autism
How to Care for a Disabled Child
SCOPE Equality for Disabled People
Health & Wellbeing
Menopause
Food Allergy
Vitamin B12 or folate deficiency anaemia
Healthy Eating
Testicular Cancer – Check Yourself
Physical Activity – The Single best Medicine
Social Prescribing
Help & Support in your Area
Lincolnshire County Council
Louth Area Autism Family Support (LAAFS)
Shine
Lincolnshire Floating Support Service
Long Term Conditions
Asthma
Breast Cancer (female)
Chronic Obstructive Pulmonary Disease (COPD)
Coronary Heart Disease
Dementia
Dementia with Lewy bodies
Diabetes
Epilepsy
High Blood Pressure (Hypertension)
Osteoarthritis
Prostate Cancer
Mental Wellbeing
Depression
Mind – For better Mental Health
Rethink Mental Illness
SANE
Time to Change
Making Space
Samaritans
Mental Health helplines
Mental health issues if you’re gay, lesbian or bisexual
Dealing with a Mental Health crisis or emergency
Feeling down or anxious? Beating the Blues 24/7 can help…
Mental Health
NHS 111 online – Get help for your symptoms
Pregnancy & Baby
Maternity Services Locations
Am I Pregnant?
Smoking affects your unborn baby
Postnatal depression
Sexual Health & Sexuality
Maria Stopes UK
Sexually Transmitted Disease
Lincolnshire Sexual Health
Free Condoms
LGBT Foundation
Gender Dysphoria
About Us
GP & Medical Student Training
Research
Resources
What happens when you are referred by your GP to see a Consultant Privately?
Put Patients First: Back General Practice Campaign
Newsletters
Over The Counter Initiative
The NHS Constitution
Friends and Family Test
Care Quality Commission
GP Earnings
Lincolnshire East Clinical Commisioning Group
Patient Representative Group
Terms of Reference of The James Street Family Practice Patient Participation Group
Minutes
Our Team
Doctors
Clinical Team
Practice Administration Team
Making the Most of your Practice
Entitlement to NHS Treatment
Practice Policies
Patient Advice
Minuteful Kidney Monitoring Privacy Policy
Accessibility
The Enhanced Data Sharing Model (EDSM)
Choose if data from your health records is shared for research and planning
Care Data
Non-Smoking Premises
Your Rights and Responsibilities
General Practice Extraction Service (GPES)
Zero Tolerance
Cookie Policy (UK)
Named GP Policy
Patient Advice and Liaison Service PALS
Safeguarding Children
The National Care Record Service (NCRS)
Accessible Information Standard
Access to your Health Records
Quality Assurance
Chaperones
Chaperone Policy
Clinical Governance
Clinical Research
Complaints
Confidentiality
Consent Protocol
Disability Access
Duty of Candour
Equality and Diversity
Freedom of Information
Infection Control Statement
NHS Patient Rights
Removal of Patients From our List
Sharing your Information with Others
Privacy Policy
Unacceptable Actions Policy
Contact
Friends & Family Test
Opening Hours
What to do when we are Closed
Extended Access
Signing Up For Patient Reference Group
Subject Access Request (SAR)
Contact Telephone Numbers
Location
Car Parking
Send a Message
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Male Urinary Tract (IPSS) Review Form
James Street Family Practice
>
Managing Your Health
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Health Review Forms
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Male Urinary Tract (IPSS) Review Form
Male Urinary Tract Review and International Prostatism Symptom Score (IPSS)
First Name
*
Last Name
*
Email
*
Enter Email
Confirm Email
*
Confirm Email
Date of birth
*
Please use format day/month/year e.g. 12/05/1979
Phone Number
*
Your IPS Score
Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating?
*
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
Over the past month, how often have you had to urinate again less than 2 hours after you finished urinating?
*
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
Over the past month, how often have you found you stopped and started again several times when you urinated?
*
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
Over the past month, how often have you found it difficult to postpone urination?
*
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
Over the past month, how often have you had a weak urinary stream?
*
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
Over the past month, how often have you had to push or strain to begin urination?
*
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?
*
None (0 points)
1 time (1 point)
2 time (2 points)
3 times (3 points)
4 times (4 points)
5 or more times (5 points)
IPSS Score
This is calculated automatically, based on the answers to the review questions.
0-7 Points:
Mild symptoms
8-19 Points:
Moderate Symptoms
20-35 Points:
Severe symptoms
Privacy Policy
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.
*
I consent to the practice collecting and storing my data from this form.
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