Submit a blood pressure reading

Blood Pressure reading

Full Name *

Address *

Date of birth *

Mobile

Landline

Instructions

sit on an upright chair with a back

rest your arm on a table and relax your hand and arm

place your feet flat on the floor

wear something with short sleeves so the cuff does not go over clothes

try to relax and avoid talking whilst using the monitor.

take another reading a few minutes after your first reading to check it’s accurate

Systolic Reading (Highest number)

Diastolic Reading (Lowest number)

Have you previously been diagnosed with hypertension (high blood pressure)? *

YES

Why have you submitted your blood pressure reading? *

My blood pressure was raised in clinic and the doctor/nurse requested I submit.

My medication review is due and I was requested to submit it.

I want to update my medical records

Other – please write in the comments box below

Comments

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