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. For more information on blood pressure and heart related issues please visit British Heart Foundation.

For information on how we keep your personal details safe, please visit our Privacy Policy page. 

Blood Pressure Review

Blood Pressure Review

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
Smoking status
We would encourage you to consider stop smoking to benefit your health. Please arrange to see our surgery smoking cessation adviser by contacting reception on 01353 663434 option 1

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
/
Evening Measurement
/

Day 3

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

Day 4

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

Day 5

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

Day 6

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

Day 7

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

Average Blood Pressure

This is automatically calculated for internal use only.

Morning Measurement

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Evening Measurement
/
*