Home Blood Pressure Form

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This page will allow you to submit your home blood pressure readings. They will be recorded in your medical records. Taking your blood pressure over a one week period once a year (or as frequently as your GP requests) and recording as shown below will help us monitor your blood pressure.


We would recommend a BP machine with an arm cuff rather then a wrist one, these can be purchased from a chemist or online and are affordable. Please watch this video for instructions on how to complete your blood pressure measurement. The picture below will help you understands the readings produced from the machine. 

Blood pressure machine labelled

How to take and record your Blood Pressure Readings:

a) It is important to take your blood pressure when you are seated and not talking.
b) Take 2 readings at least a minute apart mornings and evening and record the lowest of the two readings each time
c) Record these readings for 7 days
d) If your machine records the pulse rate also record this.
e) Fill in the name of the patient, date of birth and telephone contact (only use one form per patient)
f) The Message box is optional, please use if you think we should know about anything significant such as if you have had to stop any of your medicines.

Once you have all your readings. Please calculate your average systolic (upper value) and diastolic (lower value) for the 7 days. If required please use this online calculator for assistance. 

1 Home Blood Pressure Form

Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
Systolic (Upper value)/Diastolic (Lower value) e.g. 120/80
Please record the pulse rate if available
If required use the calculator linked above
If required please use the calculator linked above

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