Blood Pressure - Eastwood Primary Care Centre

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.

Click to Download a form to write down your readings

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

First Names*

Last Name*

Date of Birth*

NHS Number (if known) Optional

Click this link to use the NHS number finder

Who asked you to send your blood pressure readings?*

Do you smoke?*

Current Smoker

Never Smoked

Ex Smoker

Current Weight in Kg*

Click to convert stones into Kg

Current Height in metres (e.g. 1.7)*

Click to convert feet and inches to metres

BMI (Body Mass Index)*

Blood Pressure (BP Readings Day 1 )

Date of First Reading*

Example: 18/06/2021

Morning

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Evening

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

One or more of your Systolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 200 or more contact your GP practice or 111 if your practice is shut.

One or more of your Diastolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 120 or more contact your GP practice or 111 if your practice is shut.

Blood Pressure (BP Readings Day 2 )

Morning

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Evening

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Blood Pressure (BP Readings Day 3 )

Morning

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Evening

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Blood Pressure (BP Readings Day 4 )

Morning

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Evening

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Blood Pressure (BP Readings Day 5 )

Morning

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Evening

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Blood Pressure (BP Readings Day 6 )

Morning

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Evening

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Blood Pressure (BP Readings Day 7 )

Morning

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Evening

Systolic 1*

Please enter a number from 50 to 250.

Diastolic 1*

Please enter a number from 20 to 200.

Systolic 2*

Please enter a number from 50 to 250.

Diastolic 2*

Please enter a number from 20 to 200.

Calculated Average Blood Pressure

Average Systolic BP*

Average Diastolic BP*

I consent to the practice collecting and storing my data from this form.

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.