Gout Flare-Up or Management – Online AssessmentPlease complete this confidential form. Our clinician will review and respond shortly. Name * First Name Last Name Date Of Birth * MM DD YYYY Gender * Male Female Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Please provide details about your gout symptoms so we can assess if treatment is safe and appropriate. * Are you experiencing a flare-up of gout now? Yes No Which joint is affected? * Big toe Foot Ankle Knee Finger Elbow Other When did your symptoms start? * Today Within 3 days 3–7 days ago Over a week ago Is the joint red, hot, swollen, or extremely painful? * Yes No Have you had a confirmed diagnosis of gout in the past by a healthcare professional? * Yes No How often do you experience gout attacks? * This is my first A few times per year Monthly More frequent These questions help us identify if you may need urgent assessment. ⚠️ If you have answered ‘Yes’ to any of these questions, You may need an urgent in-person review. Please contact your GP or NHS 111 if your symptoms worsen or you feel unwell. * Do you have a high temperature (fever)? Yes No Do you feel unwell or have chills with this joint pain? * Yes No Is the joint pain spreading quickly or worsening rapidly? * Yes No Do you have a history of joint infection or recent surgery on this joint? * Yes No Have you used treatment for gout before? * Yes No Which treatments have you used previously? Colchicine Naproxen/NSAIDs Steroids Allopurinol None Are you currently taking any medication to prevent gout (e.g., allopurinol, febuxostat)? * Yes No Have these treatments been effective for you in the past? * Yes No Some treatments for gout may not be suitable if you have certain conditions. * Do you have any of the following? Kidney disease Liver disease Heart disease Stomach ulcers High blood pressure None Are you currently taking any prescription medications? * Yes No Please list your current medications Do you have any allergies to medications (e.g., colchicine, NSAIDs, allopurinol)? * Yes No If yes, please specify How many units of alcohol do you drink per week? * None 1–7 8-14 15+ Do you consume red meat or high-purine foods (e.g., offal, seafood, sugary drinks)? * Yes No Are you overweight or have you gained weight recently? * Yes No Do you have a family history of gout? * Yes No Are you registered to a GP? * Yes No GP Surgery Name Would you like us to notify your GP of this consultation? * Yes No Consent & Declaration * I confirm that the information I’ve provided is accurate and complete. I understand that treatment may include pain relief and anti-inflammatory medications. I agree to follow dosing instructions and avoid alcohol during treatment. I will seek further medical advice if my symptoms worsen or do not improve. I consent to this consultation being used for medical assessment and prescribing. Thank you! Your gout consultation has been submitted. A clinician will review your answers and be in touch shortly.
