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Continence Clinic Self-Referral Form

 

Patients experiencing continence problems can self-refer to the Continence Clinic based at the City Hospital.  Symptoms may include:-

   Leakage of urine when coughing/laughing

   Leakage of urine with strong desire to pass urine

ÿ Unaware when urine is passed

 

Please complete the attached self referral form and send it to the address indicated on the form.

 

Continence Clinic Self Referral Form



 
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