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Striving for a culture of excellence in all
aspects of primary healthcare provision

Blood Pressure Monitoring Form (monthly)

Please only complete this form if your GP has requested you to do so

The fields that are in red are required fields so they must be completed before submitting the form.

 

 Name
 
 Date of Birth
 
 Do you smoke?
 
 If you are a current smoker, we would recommend stopping smoking. If you want to, please ask for an appointment with one of our smoking cessation advisors.
 Date
 
 1st BP reading
 
 2nd BP reading
 
 3rd BP reading