FREQUENCY/VOLUME CHART.

DEPARTMENT of UROLOGY

Name:…

Date of Birth:…

FREQUENCY/VOLUME CHART.

On each day that you keep a record, please note the time you pass water and the volume you pass and write both on the chart.

Try to keep a record on the days when you are able to measure every time that you pass water. If you are not able to record the volume just record the time.

If you wet yourself at any time, record the time and write the letter W.

Night time is when you would normally be asleep in bed, if you are woken up and have to get out of bed to pass water. This is not the first time you pass water after getting up in.

DAY 1			DAY 2			DAY 3			DAY 4
TIME	VOLUME		TIME	VOLUME		TIME	VOLUME		TIME	VOLUME
NIGHT - TIME