Name:
Date of birth:
This booklet contains three charts for you to complete to provide the continence team with some essential information ready for your full assessment. The charts should be completed over the same four days. These should be completed as well as the questionnaire we have sent you.
The charts will show us your bowel and bladder activity and what you eat and drink on an average day. We ask that you complete these on a 'normal' day rather than when you are on holiday or at a special occasion such as a wedding, as your eating and drinking may be different.
It is very important that we understand both your bowel and bladder activity as these impact on each other and therefore ask that you complete all three charts, not just the one which records any difficulties you are having.
For support with completing the charts, please refer to the user guide here. If you need further guidance do not hesitate to contact us:
- 01737 777712
- fchc.continence@nhs.net
Once the team receive your returned charts and questionnaire you will be contacted to make an appointment for your first consultation.
The below charts can be returned to the team either by email or post:
- fchc.continence@nhs.net
- Continence team, Consort House, 5-7 Queensway, Redhill, Surrey, RH1 1YB.
