RDHG - Blood Pressure Monitor

Only use this form if you have been advised by the surgery to submit your blood pressure readings.

Last Updated: 06/04/2020

Blood Pressure Reading Instructions

Your Details

Name *

Date of Birth *

Phone Number *

Email Address

Enter Blood Pressure Data

Please enter your readings using this example - 120/86

Day 1 - Date *

A.M BP Reading *

P.M BP Reading *

Day 2 - Date *

A.M BP Reading *

P.M BP Reading *

Day 3 - Date *

A.M BP Reading *

P.M BP Reading *

Day 4 - Date *

A.M BP Reading *

P.M BP Reading *

Day 5 - Date *

A.M BP Reading *

P.M BP Reading *

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. * *

I consent to the practice collecting and storing my data from this form.

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RDHG - Blood Pressure Monitor

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