Blood Pressure Review

If you have been asked to submit some blood pressure readings to the Surgery you can use the form below.

How to take your Blood Pressure Readings

In the morning, ensure you are rested and have taken no exercise in the last 30 minutes.

Sit in a chair comfortably upright with your arm supported on a table beside you with both feet on the ground.

Put the cuff on your upper arm (5cm above your elbow) resting on the table.  The cuff should roughly be at the level of your heart.

Press the On/Start button on the BP monitor and take two readings at least 1 minute apart.

Repeat in the evening for a total of 7 days using alternate arms.  Make a note of the readings and your pulse rate

Once you have completed 7 days worth of readings, please add these to the form below and submit to the Surgery.

If you are using one of our blood pressure monitors, please return it to the Surgery as soon as possible so this can be passed to another patient.

Blood Pressure Review

Blood Pressure Review

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
Smoking status

Your Blood Pressure

Please provide a minimum of one blood pressure reading, up to a maximum of seven.

Day 1

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 2

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 3

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 4

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 5

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 6

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 7

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Average Blood Pressure

This is automatically calculated for internal use only.

Morning Measurement

/
Evening Measurement
/
*