Blood Pressure Review

If you have been advised by the surgery to submit your blood pressure readings on a regular basis please use this form.

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.
Please specify: *

Your Blood Pressure

  • In the morning, ensure that you are rested and have taken no exercise in the last 30 minutes.
  • Then 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 be roughly at the level of your heart.
  • Press the on/start button on the BP monitor and take two readings at least 1 minute apart.
  • Record the readings below with your pulse rate and any comments.
  • Repeat that evening & for a total of 7 days using alternate arms. Then return this diary (& BP monitor if borrowed) to the surgery.

Day 1

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
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Which arm did you take this reading from? *
2nd Morning Measurement
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Which arm did you take this reading from? *
1st Evening Measurement
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Which arm did you take this reading from? *
2nd Evening Measurement
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Which arm did you take this reading from? *

Day 2

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
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Which arm did you take this reading from? *
2nd Morning Measurement
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Which arm did you take this reading from? *
1st Evening Measurement
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Which arm did you take this reading from? *
2nd Evening Measurement
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Which arm did you take this reading from? *

Day 3

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
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Which arm did you take this reading from? *
2nd Morning Measurement
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Which arm did you take this reading from? *
1st Evening Measurement
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Which arm did you take this reading from? *
2nd Evening Measurement
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Which arm did you take this reading from? *

Day 4

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
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Which arm did you take this reading from? *
2nd Morning Measurement
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Which arm did you take this reading from? *
1st Evening Measurement
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Which arm did you take this reading from? *
2nd Evening Measurement
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Which arm did you take this reading from? *

Day 5

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
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Which arm did you take this reading from? *
2nd Morning Measurement
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Which arm did you take this reading from? *
1st Evening Measurement
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Which arm did you take this reading from? *
2nd Evening Measurement
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Which arm did you take this reading from? *

Day 6

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
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Which arm did you take this reading from? *
2nd Morning Measurement
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Which arm did you take this reading from? *
1st Evening Measurement
/
Which arm did you take this reading from? *
2nd Evening Measurement
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Which arm did you take this reading from? *

Day 7

Please use this date format: DD/MM/YYYY.
1st Morning Measurement
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Which arm did you take this reading from? *
2nd Morning Measurement
/
Which arm did you take this reading from? *
1st Evening Measurement
/
Which arm did you take this reading from? *
2nd Evening Measurement
/
Which arm did you take this reading from? *

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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