Recording blood pressure readings

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

Download Blood Pressure Readings Diary

Please monitor and record your blood pressure at home for seven consecutive days (unless you have been advised otherwise).

Use the form to record all of your blood pressure readings. The numbers you input should be the same as those that appear on the blood pressure monitor screen – do not round the numbers up or down. Each time take a minimum of two readings, leaving at least a minute between each. If the first two readings are very different, take two or three further readings.

In the notes section, you should also write down anything that could have affected your readings, such as feeling unwell or changes to your medication. Please also record your pulse/heart rate.

Instructions for taking blood pressure

On each day monitor your blood pressure on two occasions:

morning between 6am and 12 noon
evening between 6pm and midnight.

When taking your blood pressure:

before you start, ensure at least 30 minutes have passed without drinking caffeine or smoking

sit with your arm supported on a table or at heart level. Keep your legs uncrossed; stay relaxed

check cuff placement is correct

rest for one minute, then check blood pressure

repeat the process twice more and enter the lowest reading

write down the results, then complete and submit your form after seven days. You can email the completed form to stmarysely-reminder@nhs.net or drop it into the surgery.

Online Blood Pressure Form

Please provide your blood pressure readings for 7 consecutive days (unless you have been advised otherwise). You should take a reading twice each day – once in the morning and once in the evening. The form has been designed for you to easily record your daily BP readings.

"*" indicates required fields

Step 1 of 2

Name*

‏‏‎ ‎ ‏‏‎ ‎

Date of Birth*

NHS number Optional

Please add your NHS number if you know it

Address*Please enter your full address

Street Address Address Line 2 City Post Code

Phone*

Email Optional

By giving us your email address on this online form, we assume consent to reply to this form via email when necessary. If you prefer not to receive email, please contact the surgery by telephone.

What is your smoking status?

Smoker Optional

Never smoked Optional

Ex-smoker Optional

Instructions for taking your blood pressure

On each day monitor your blood pressure on two occasions:

morning between 6am and 12 noon
evening between 6pm and midnight.

While taking your blood pressure:

before you start, ensure at least 30 minutes have passed without drinking caffeine or smoking
sit with your arm supported on a table or at heart level. Keep your legs uncrossed; stay relaxed
check cuff placement is correct
rest for one minute, then check blood pressure
repeat the process twice more and enter the lowest reading.

Date*

Readings in the morning*

Systolic (top number)

Diastolic (bottom number)

Readings in the evening*

Systolic (top number)

Diastolic (bottom number)

Date*

Readings in the morning*

Systolic (top number)

Diastolic (bottom number)

Readings in the evening*

Systolic (top number)

Diastolic (bottom number)

Date*

Readings in the morning*

Systolic (top number)

Diastolic (bottom number)

Readings in the evening*

Systolic (top number)

Diastolic (bottom number)

Date*

Readings in the morning*

Systolic (top number)

Diastolic (bottom number)

Readings in the evening*

Systolic (top number)

Diastolic (bottom number)

Date*

Readings in the morning*

Systolic (top number)

Diastolic (bottom number)

Readings in the evening*

Systolic (top number)

Diastolic (bottom number)

Date*

Readings in the morning*

Systolic (top number)

Diastolic (bottom number)

Readings in the evening*

Systolic (top number)

Diastolic (bottom number)

Date*

Readings in the morning*

Systolic (top number)

Diastolic (bottom number)

Readings in the evening*

Systolic (top number)

Diastolic (bottom number)

Additional comments Optional

Please add any details that could have affected your reading, such as feeling unwell or changes in your medication.

I consent to St Mary’s Surgery collecting and storing my data from this form.

Comments Optional

This field is for validation purposes and should be left unchanged.

Updated: 30.08.22