Severn View Family Practice

"Delivering the right care to the right people at the right time"

Online Blood Pressure Form

On-Line Blood Pressure Submission

This page will allow you to submit your (averaged) home readings without having to visit the surgery.
If you are on blood pressure treatment and have access to a home blood pressure machine and would like to submit your average readings to us, we will record this on your medical records. Taking you blood pressure every six months and recording as shown below will help us monitor your blood pressure.
We would recommend a BP machine with an arm cuff, not a wrist one, these can purchase from a chemist and are relatively cheap.

How to take and record your Blood Pressure Readings.

  1. a) It is important to take your blood pressure when you are seated and not talking.
    b) Take 2 readings at least a minute apart mornings and evening and record thelowestof the two readings each time
    c) Record these readings for 7 days
    d) If your machine records the pulse rate also record these.
    e) Fill in the name of the patient, date of birth and telephone contact (only use one form per patient)
    f) The Message box is optional, please use if you think we should know about anything significant such as if you have had to stop any of your medicines.


Ensure that all the information boxes below are completed in full
Then press “submit”

Please take 2 (Two) readings 1minute apart am and pm for 7 days.
(Put the lowest reading down only)
Please include date, time, Systolic (top), Diastolic (bottom) and pulse.
Please include date, time, Systolic (top), Diastolic (bottom) and pulse.
Please include date, time, Systolic (top), Diastolic (bottom) and pulse.
Please include date, time, Systolic (top), Diastolic (bottom) and pulse.
Please include date, time, Systolic (top), Diastolic (bottom) and pulse.
Please include date, time, Systolic (top), Diastolic (bottom) and pulse.
Please include date, time, Systolic (top), Diastolic (bottom) and pulse.
This form is sent to us in a non-ecrypted format.
Complete confidentiality for completing this type of form can not be guaranteed.
If you have an issue with this please click on this link to print the form, complete and send by post