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

Please ensure you have read the instructions on your blood pressure monitoring machine:

• Step 1: Place the blood pressure monitoring cuff on your arm and sit comfortably in an upright seated position.
• Step 2: Start the machine and record the time and the reading of the systolic (high number) and the diastolic (lower number) in the boxes.
• Step 3: Rest for 1 minute then repeat, documenting the reading in BP Reading 2. If your machine displays your heart rate, please record this number (normally in BPM, also known as Beats Per Minute.)
• Step 4: Repeat steps 1-3 later in the day using boxes BP Reading 3 and BP Reading 4.
• Step 5: Repeat the above for 7 days or a minimum of 4 consecutive days before handing back to your GP or practice.