BP: Submit your blood pressure reading

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For patients who suffer from high blood pressure we encourage them to check their BLOOD PRESSURE at HOME as this often gives the best most accurate readings. Sometimes if see the Doctor it may go up - this is called 'white coat syndrome'

**We need only 1 BP reading per YEAR unless you have been told by the surgery for more

Your Details

Please include your latest personal details so that we can contact you if necessary

Your Full Name *

Your Date of Birth *

Please include your DOB in the form of DD/MM/YYYY i.e 01/01/1980

YYYY

Your MOBILE number

If we need to contact you to clarify your answers especially if it HIGH

Your EMAIL address

If we need to contact you to clarify your answers especially if it HIGH

BLOOD PRESSURE

Please submit your blood pressure below. If your BP is above 200/110 please go to AE or ring 111

BP: Your SYSTOLIC blood pressure *

Please submit the TOP blood pressure reading i.e. 120 / 80 - Please type 120 below

Your DIASTOLIC blood pressure *

Please submit the BOTTOM blood pressure reading ie 120 / 80 - Please type 80 below

Other health information

SMOKING: Do you smoke? If so how many? *

Please inform us of your smoking habits including not smoked, ex-smoker or current smoker. If you do smoke and want to stop please ring One for Haringey on 0208 885 9095 or visit: https://www.oneyouharingey.org/

ALCOHOL: Do You drink? How many units in a week? *

1 pint of beer is approximately two units and one small glass of wine is 1 unit

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