Goodinge Group Practice NHS GP Surgery in London

Blood pressure review (single day reading)

Blood Pressure Review (single day reading)

Smoking status

Smoker

Never smoked

Ex-smoker

How many per day do you smoke?

When did you give up smoking?

Your Blood Pressure

Please provide one Blood Pressure and Heart Rate reading as directed by a member of the team. This is usually for monitoring of medication and general wellbeing. If It is raised then you will be contacted by a member of the team to do several readings.

For information on blood pressure and blood pressure measurements, please visit our Wellbeing Centre.

Date:

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

Morning Measurement

Systolic “Higher”

/

Diastolic “Lower”

Heart Rate

Evening Measurement

Systolic “Higher”

/

Diastolic “Lower”

Heart Rate

*

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