Blood Pressure Reading Form

Last Updated: 05/08/2021

About You









Your Blood Pressure

Provide Blood Pressure Reading Take your blood pressure, using an accurate device, whilst seated with your arm and back supported, legs uncrossed and whilst you are not talking. The first time you measure your blood pressure measure on both arms. In future use which ever arm gives the higher result. Inform you GP if there is a difference between the two arms of >20. Take two readings a minute apart. Should there be a substantial difference measure a third time. The lowest of the readings is the most accurate. Measure blood pressure morning and evening for seven days. You can document you readings on this Form. You can take the form to your Surgery or preferably send the readings to your GP using this online form. Please select the surgery you are from below and use the form to provide us with your home blood pressure reading. If you measured your blood pressure more than once then enter the different readings into the table and the web-page will calculate the average for you. If your blood pressure machine displays your heart rate then please enter it on the form. We aim to have your doctor review the blood pressure reading within three working days, but at busy times it may take longer.

Day 1








Day 2








Day 3








Day 4








Day 5








Day 6








Day 7








Average Blood Pressure

Add all your Heart rates for each morning then divide by how many days. Do the same for Systolic "Higher" and Diastolic "Lower" and then for the Evening as well.