International Prostate Symptom Score (IPSS)

International Prostate Symptom Score (IPSS)

If you have been advised by your doctor to submit an International Prostate Symptom Score (IPSS), please use this form, and please remember to add the name of the doctor who asked you to do so. 

DO NOT SUBMIT THIS FORM IF YOU HAVE NOT SPOKEN TO A DOCTOR ABOUT YOUR SYMPTOMS AND BEEN ASKED TO DO SO.  Unsolicited forms sent to the Practice will not be read and will be deleted automatically.

  • Your Details

    Date of Birth
    For example, 15 3 1984

  • Urinary Tract Symptoms

    Please answer the following questions, thinking about, in general, how often you've noticed any of the symptoms OVER THE PAST MONTH.

    How often has your bladder felt as thought it's not completely empty after finishing urinating?
    How often have you needed to pass urine again within 2 hours of last urinating?
    How often has the flow stopped and started several times when urinating?
    How often has it been hard to delay urinating after first feeling the need?
    How often has the urine flow seemed poor or weak?
    How often have you needed to push or strain to begin urinating?
    On average, from the time you've gone to bed, until the time you've got up in the morning, how many times have you needed to get up to urinate?
    If you had to spend the rest of your life with your urinary symptoms staying just they way they are at the moment, how would you feel?
    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.
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Page last reviewed: 27 February 2026
Page created: 27 February 2026