Home Blood Pressure Monitoring "*" indicates required fields About YouFirst Names*Last Name*Date of Birth* DD slash MM slash YYYY NHS Number (if known) Optional Click this link to use the NHS number finder Who asked you to send your blood pressure readings?*Pharmacy Cardiology TeamGP PracticeChoose your GP Practice from this list*Eastwood Primary Care CentreDo you smoke?* Current Smoker Never Smoked Ex Smoker Current Weight in Kg* Click to convert stones into Kg Current Height in metres (e.g. 1.7)* Click to convert feet and inches to metres BMI (Body Mass Index)*Blood Pressure (BP Readings Day 1 )Date of First Reading* DD dash MM dash YYYY Example: 18/06/2021MorningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.EveningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.One or more of your Systolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 200 or more contact your GP practice or 111 if your practice is shut.One or more of your Diastolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 120 or more contact your GP practice or 111 if your practice is shut.Blood Pressure (BP Readings Day 2 )MorningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.EveningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.One or more of your Systolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 200 or more contact your GP practice or 111 if your practice is shut.One or more of your Diastolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 120 or more contact your GP practice or 111 if your practice is shut.Blood Pressure (BP Readings Day 3 )MorningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.EveningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.One or more of your Systolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 200 or more contact your GP practice or 111 if your practice is shut.One or more of your Diastolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 120 or more contact your GP practice or 111 if your practice is shut.Blood Pressure (BP Readings Day 4 )MorningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.EveningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.One or more of your Systolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 200 or more contact your GP practice or 111 if your practice is shut.One or more of your Diastolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 120 or more contact your GP practice or 111 if your practice is shut.Blood Pressure (BP Readings Day 5 )MorningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.EveningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.One or more of your Systolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 200 or more contact your GP practice or 111 if your practice is shut.One or more of your Diastolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 120 or more contact your GP practice or 111 if your practice is shut.Blood Pressure (BP Readings Day 6 )MorningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.EveningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.One or more of your Systolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 200 or more contact your GP practice or 111 if your practice is shut./Blood Pressure (BP Readings Day 7 )MorningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.EveningSystolic 1*Please enter a number from 50 to 250.Diastolic 1*Please enter a number from 20 to 200.Systolic 2*Please enter a number from 50 to 250.Diastolic 2*Please enter a number from 20 to 200.One or more of your Systolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 200 or more contact your GP practice or 111 if your practice is shut.One or more of your Diastolic readings is high. Check you have entered the number correctly. If it is correct, then please retake your BP at least 3 times. If the number is still 120 or more contact your GP practice or 111 if your practice is shut.Calculated Average Blood PressureAverage Systolic BP*Average Diastolic BP*Privacy Policy* I consent to the practice collecting and storing my data from this form. This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible. We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. If you are not completely happy to provide information via the internet please contact the practice directly.
