Hypertension Blood Pressure Readings Form

Please take your readings using a home monitor. If you do not have access to a blood pressure machine, please contact the surgery to make a routine appointment with a nurse or health care assistant.

Hypertension Blood Pressure Readings

Patient Details

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

Blood Pressure Readings (Day 1, 2, 3)

Make sure you are sat comfortably. Take your first reading, wait 5 minutes, and take your blood pressure again disregarding the first reading.

Alcohol

This is one unit of alcohol:

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

Weekly consumption, please write how many of each you consume in one week:

Smoking