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.

How to take your Blood Pressure correctly

  • Monitor from your upper arm. Sit with your back and arm supported, uncrossed legs and no talking.
  • Measure your Blood Pressure in both arms. If there is a consistent difference of 20 units or over, then always use the arm with the highest reading.
  • Take 2 readings preferably 5 minutes apart in the mornings and afternoons over 7 days and record the readings below.

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
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Evening Measurement
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Day 2

Please use this date format: DD/MM/YYYY.
Morning Measurement
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Evening Measurement
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Day 3

Please use this date format: DD/MM/YYYY.
Morning Measurement
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Evening Measurement
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Day 4

Please use this date format: DD/MM/YYYY.
Morning Measurement
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Evening Measurement
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Day 5

Please use this date format: DD/MM/YYYY.
Morning Measurement
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Evening Measurement
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Day 6

Please use this date format: DD/MM/YYYY.
Morning Measurement
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Evening Measurement
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Day 7

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

This is automatically calculated for internal use only.

Morning Measurement

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Evening Measurement
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