Blood Pressure Review

If you have been advised by the surgery to submit readings of your blood pressure please use this form.

For more information on blood pressure please see our Wellbeing Centre.

Blood Pressure Review (2 readings)

Blood Pressure Review (2 readings)

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 days’ readings.

For each blood pressure recording provided, at least two consecutive measurements should be taken, at least one minute apart.

For information on blood pressure and blood pressure measurements, please visit our Wellbeing Centre.

Day 1

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
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2nd Morning Measurement
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1st Evening Measurement
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2nd Evening Measurement
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Day 2

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
/
2nd Morning Measurement
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1st Evening Measurement
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2nd Evening Measurement
/

Day 3

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
/
2nd Morning Measurement
/
1st Evening Measurement
/
2nd Evening Measurement
/

Day 4

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
/
2nd Morning Measurement
/
1st Evening Measurement
/
2nd Evening Measurement
/

Day 5

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
/
2nd Morning Measurement
/
1st Evening Measurement
/
2nd Evening Measurement
/

Day 6

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
/
2nd Morning Measurement
/
1st Evening Measurement
/
2nd Evening Measurement
/

Day 7

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
/
2nd Morning Measurement
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1st Evening Measurement
/
2nd Evening Measurement
/

Average Blood Pressure

This is automatically calculated for internal use only.

Please note: These averages do not include Day 1 readings.

Morning Measurement

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Evening Measurement
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Home Blood Pressure Measurement (HBPM) - Your Overall Average
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*