Submit Your Blood Pressure Readings

Please use this form to submit your blood pressure readings.

If you are unsure how to take your blood pressure correctly, or would like to see a list of recommended blood pressure monitors, please visit our hypertension page for guidance.

**If you have previously submitted the questions in section 2, please feel free to skip those.

Last Updated: 08/11/2022

Your Details

Name: *

Date of Birth: *

Contact Number: *

Please fill in this information the first time you submit this form **This information is only required to be submitted once**

Weight:

Height:

Alcohol Consumption (per week)

Are you a smoker?

Yes No

Blood Pressure Readings

Please input both your MORNING and EVENING readings from days 1-7 in the format of eg. 135/85.

If you have missed a reading, please just enter 0.

Day 1 - MORNING *

Day 1 - AFTERNOON *

Day 2 - MORNING *

Day 2 - AFTERNOON *

Day 3 - MORNING *

Day 3 - AFTERNOON *

Day 4 - MORNING *

Day 4 - AFTERNOON *

Day 5 - MORNING *

Day 5 - AFTERNOON *

Day 6 - MORNING *

Day 6 - AFTERNOON *

Day 7 - MORNING *

Day 7 - AFTERNOON *

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Submit Your Blood Pressure Readings

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