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.

Blood Pressure Review

Blood Pressure Review

About You

Please use this date format: DD/MM/YYYY.

Your Blood Pressure

You can submit blood pressure readings in various ways

  • An average of readings done on a home monitor, ideally from readings taken
    morning and evening for 1 week.
  • A reading taken on the monitor in the surgery of the waiting room
  • A reading taken by the health care assistant at the surgery

Latest blood pressure reading

Your Weight

Please use the scales in the surgery of you wish

Smoking Status

Do you smoke?

Alcohol Consumption

Alcohol intake per week for:

Do you have any of the following?

Chest pains
Breathlessness (not explained by known medical condition)
Pains in your legs when walking
Side effects from your tablets

Your Review

How would you prefer to be reviewed?

Please note that the details you give will be used to update your medical records.