If you have previously used this pain relieving medication, please indicate if it has caused you any problems with any side effects?
Do you exceed the current weekly maximum amount of alcohol consumption (UK: 21units male, 14units female). If so how much do you drink and how often?
Are you taking any other medications (including both prescribed and self-purchased medicines)? If yes, please specify the name, strength and dosage of each medicine and the reason why you take it.
Are there other illnesses or underlying medical conditions or medical investigations the prescriber needs to be aware of?
Do you have any bowel or bladder difficulties (such as finding it difficult to hold in urine or stools) and / or numbness around your bottom / between your legs?
Do you have any symptoms of poor flow of urine or dribbling or increased frequency and /or urge or any symptoms of urinary incontinence and numbness around your bottom / between your legs?
Do you suffer from, diarrhoea or fever? Do you have an infection of the bronchial tubes, nose, ears, prostate or Sexually Transmitted Diseases or any other symptoms that might indicate you have an infection?
