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

About You

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

Your Blood Pressure

Please take two readings at least one minute apart in the morning, and two readings at least one minute apart in the evening. Write down the lowest figure and enter them in this form for one week.

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
/
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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