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.

The ideal blood pressure targets are less than 140/90mmHg for those aged under 80 and less than 150/90mmHg for those aged 80 and above.

Please rest for five minutes and take three blood pressure readings and document the lowest reading:

If this is above the target above, then please check your blood pressure twice a day for seven days and submit your readings below and the average will be calculated for you.

Your annual blood tests for Hypertension (high blood pressure) are usually done in your birth month unless you are having them checked more frequently for any other reason.

Please call the medical centre to book in for your blood tests if this is your annual review month and inform the receptionists that you need to book in for your CHRONIC DISEASE MANAGEMENT ANNUAL BLOOD TESTS.

Blood Pressure Review

Blood Pressure Review

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
Smoking status: *
We would strongly encourage you have your annual flu vaccination to reduce the risk of complicated asthma exacerbations and chest infections: *

This is one unit of alcohol:

Amount of different types of drink representing one unit of alcohol

And each one of these, is more than one unit:

Amount of different types of drink representing more than one unit of alcohol
How often do you have a drink containing alcohol? *
How many units of alcohol do you drink on a typical day when you are drinking? *
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? *

Your Blood Pressure

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

Day 1

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 2

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 3

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 4

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 5

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 6

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Day 7

Please use this date format: DD/MM/YYYY.
Morning Measurement
/
Evening Measurement
/

Average Blood Pressure

This is automatically calculated for internal use only.

Morning Measurement

/
Evening Measurement
/
*