Blood Pressure Pathway

Submit your home BP readings using the form below

New Forest PCN practices are working together to look for people with undiagnosed High Blood Pressure.

Use the form below to submit your home readings. You will then be contacted regarding any further action which may be recommended.

PCN Home BP Submission

Full Name *

Date of Birth *

First line of address *

What surgery are you registered at?

Height

Weight

Smoking status

Never Smoked

Ex-Smoker

Current Smoker

Do you drink alcohol?

Yes

How many units in an average week?

To work out how many units you drink in an average week you can use the calculator found at this website.

Ethnicity

What date did you start your readings?

Day 1

Morning 1 Systolic *

Morning 1 Diastolic *

Morning 2 Systolic *

Morning 2 Diastolic *

Evening 1 Systolic *

Evening 1 Diastolic *

Evening 2 Systolic *

Evening 2 Diastolic *

Day 2

Morning 1 Systolic *

Morning 1 Diastolic *

Morning 2 Systolic *

Morning 2 Diastolic *

Evening 1 Systolic *

Evening 1 Diastolic *

Evening 2 Systolic *

Evening 2 Diastolic *

Day 3

Morning 1 Systolic *

Morning 1 Diastolic *

Morning 2 Systolic *

Morning 2 Diastolic *

Evening 1 Systolic *

Evening 1 Diastolic *

Evening 2 Systolic *

Evening 2 Diastolic *

Day 4

Morning 1 Systolic *

Morning 1 Diastolic *

Morning 2 Systolic *

Morning 2 Diastolic *

Evening 1 Systolic *

Evening 1 Diastolic *

Evening 2 Systolic *

Evening 2 Diastolic *

Day 5

Morning 1 Systolic *

Morning 1 Diastolic *

Morning 2 Systolic *

Morning 2 Diastolic *

Evening 1 Systolic *

Evening 1 Diastolic *

Evening 2 Systolic *

Evening 2 Diastolic *

Results

Results appear once enough data has been entered above.

Average Systolic Days 2-5

Average Diastolic Days 2-5

If you are human, leave this field blank.