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.

Please monitor and record your blood pressure at home for 7 consecutive days (unless you have been advised otherwise). On each day, monitor your blood pressure on two occasions – in the morning (between 6am and 12noon) and again in the evening (between 6pm and midnight). We recommend you take three readings, please record your best reading out of three results.

1. In the morning and evening, ensure that you are rested and have taken no exercise in the last 30 minutes.

2. Then sit in a chair comfortably upright with your arm supported on a table beside you, with both feet on the ground.

3. 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.

4. Press the on/start button on the BP monitor and take three readings at least 1 minute apart.

5. Record the best readings out of three you have taken using this form.

Blood Pressure Review

Blood Pressure Review

Smoking status

Your Blood Pressure

Pressure 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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*