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.

If you require your full annual hypertension review, please complete this form and book a 20 minute appointment with our HCA. Please submit this BP form beforehand.

Smoking status

Your blood pressure

Please provide a minimum of one blood pressure reading, up to a maximum of seven.

Day 1

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80

Day 2

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80

Day 3

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80

Day 4

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80

Day 5

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80

Day 6

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80

Day 7

Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80
Please provide your blood pressure reading e.g. 120/80