Blood Pressure and Weight Review

If you have been advised by the surgery to submit your blood pressure readings on a regular basis please use this form.

If you have been provided with a home BP machine, please read the information on our Blood Pressure Home Monitoring page and follow the instructions.

You should measure your blood pressure twice a day, ideally in the morning and in the evening, while you are sitting down quietly. Check the cuff is positioned correctly, as per the instructions.

Each time you take your blood pressure, you should take two readings, 1 minute apart. You should continue to measure your blood pressure twice daily for at least 4 days and ideally for 7 days. Use all the readings to work your average blood pressure.​  An explanation of how to calculate the average is below.

For most people an ideal average home blood pressure is between 110/60 and 135/85.

Blood Pressure and Weight Review

Blood Pressure and Weight Review

Section

Smoking status

Your Blood Pressure

Please 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
/
Overall Average
/

BMI

Measurement: *
e.g 1.75
e.g 60.6
e.g 70
e.g 120

*
*