Blood Pressure

Home Blood Pressure Monitoring

Only complete this form if you are asked to by the practice or clinical pharmacy team

The NHS and your GP want you to keep your blood pressure just right.

  • This is how to check your blood pressure
  • Get something to write your readings down on – you can download a form above
  • Do it after taking your medications
  • Sit calmly for five minutes
  • Put the cuff on your upper arm (always use the same arm) Relax. Rest your hand on something
  • The Systolic is the top, higher number and the Diastolic is the bottom, lower number
  • Press the button on the blood pressure machine to take a reading. Do not talk. This can cause a higher reading. Write this reading down
  • After one minute take a second blood pressure reading. Write it down
  • Do this morning and night for at least 7 days.
  • Submit your readings in the form below

"*" indicates required fields

About You

DD slash MM slash YYYY
Do you smoke?*

Blood Pressure (BP Readings Day 1 )

DD dash MM dash YYYY
Example: 18/06/2021

Morning

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Evening

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Blood Pressure (BP Readings Day 2 )

Morning

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Evening

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Blood Pressure (BP Readings Day 3 )

Morning

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Evening

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Blood Pressure (BP Readings Day 4 )

Morning

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Evening

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Blood Pressure (BP Readings Day 5 )

Morning

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Evening

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Blood Pressure (BP Readings Day 6 )

Morning

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Evening

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

/

Blood Pressure (BP Readings Day 7 )

Morning

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Evening

Please enter a number from 50 to 250.
Please enter a number from 20 to 200.
Please enter a number from 50 to 250.
Please enter a number from 20 to 200.

Calculated Average Blood Pressure

Privacy Policy*
This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible. We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. If you are not completely happy to provide information via the internet please contact the practice directly.