Blood Pressure Review – 1 Day Reading | Cranleigh Medical Practice

If you have been requested by the surgery to submit one day blood pressure readings or for periodic blood pressure submissions please use this form.

Blood Pressure Review - 1 Day Reading

If you are human, leave this field blank.

Address:

Smoking status

Smoker

Never smoked

Ex-smoker

How many per day do you smoke?

When did you give up smoking?

Please provide two readings taken 5 minutes apart.

Date:

Please use this date format: DD/MM/YYYY.

Reading 1

Systolic "Higher"

Diastolic "Lower"

Heart Rate

Reading 2

Systolic "Higher"

Diastolic "Lower"

Heart Rate

I confirm that the information provided is accurate to the best of my knowledge

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