Online Blood Pressure Form

This page will allow you to submit your (averaged) home readings without having to visit the surgery.If you are on blood pressure treatment and have access to a home blood pressure machine and would like to submit your average readings to us, we will record this on your medical records. Taking you blood pressure every six months and recording as shown below will help us monitor your blood pressure.

We would recommend a BP machine with an arm cuff, not a wrist one, these can purchase from a chemist and are relatively cheap.

How to take and record your Blood Pressure Readings.

a) It is important to take your blood pressure when you are seated and not talking.
b) Take 2 readings at least a minute apart mornings and evening and record the lowest of the two readings each timec) Record these readings for 7 days
d) If your machine records the pulse rate also record these.
e) Fill in the name of the patient, date of birth and telephone contact (only use one form per patient)
f) The Message box is optional, please use if you think we should know about anything significant such as if you have had to stop any of your medicines.


Ensure that all the information boxes below are completed in full

Then press “submit”

Smoking status

Your blood pressure

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

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