Home Blood Pressure Reading

Please complete this questionnaire if requested by your GP Practice. If you have a SystmOnline account please use this to submit your readings.

Instructions:

In the morning, ensure that you are rested and have taken no exercise in the last 30 minutes.
Then sit in a chair comfortably upright with your arm supported on a table beside you, with both feet on the ground.
Put the cuff on your upper arm (5cm above your elbow) resting on the table, the cuff should be roughly at the level of your heart.
Press the on/start button on the BP monitor and take two readings at least 1 minute apart.
Record the second reading below with your pulse rate and any comments.
Repeat that morning & evening for a total of 7 consecutive days using alternate arms.

For a list of validated home blood pressure monitors, visit bihsoc.org/bp-monitors or discuss with your pharmacy

Please select the practice location most relevant to this Online Form submission:

Home Blood Pressure Reading

Name

Date of BirthPlease enter Date of Birth as DD/MM/YYYY

Home Blood Pressure:

Please submit readings for seven consecutive days, one reading for the morning and one reading for the evening.

Day 1: AM-

Day 1: PM-

Day 2: AM-

Day 2: PM-

Day 3: AM-

Day 3: PM-

Day 4: AM-

Day 4: PM-

Day 5: AM-

Day 5: PM-

Day 6: AM-

Day 6: PM-

Day 7: AM-

Day 7: PM-

Pulse Rate

I would like to add the following comments:

NEXT STEP

Thank you for submitting your readings. They will be reviewed by one of our Healthcare Professionals who will be in contact if we require any further information.

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