Patient Name: ____________________________ DOB: ____________________________________
VOIDING DIARY/POOP DIARY Date
Time
Amount of Urine
Comments
J. Lynn Teague, MD Regina Monroe, MD Pediatric Urology 200 Patewood Drive, Suite A115, Greenville, SC 29615 Phone: (864) 454-5135 Fax: (864) 241-9200
Poop Type