Blood Pressure Readings

Step 1 of 3

Name Required

First Last

Date of Birth Required

Email Required

Phone Number Required

What is your smoking status? Required

Smoker

Never smoked

Ex-smoker

How many do you smoke each day? Required

When did you give up smoking? Required

Your Blood Pressure

Please provide a minimum of one day blood pressure readings, up to a maximum of seven days. Take a readings in the morning and in the evening of each day.

Day 1

Date Required

Readings in the Morning

Heart rate morning Required

Systolic morning Required

Diastolic morning Required

Readings in the Evening

Heart rate evening Required

Systolic evening Required

Diastolic evening Required

Day 2

Date Required

Readings in the Morning

Heart rate morning Optional

Systolic morning Required

Diastolic morning Required

Readings in the Evening

Heart rate evening Optional

Systolic evening Required

Diastolic evening Required

Day 3

Date Required

Readings in the Morning

Heart rate morning Optional

Systolic morning Required

Diastolic morning Required

Readings in the Evening

Heart rate evening Optional

Systolic evening Required

Diastolic evening Required

Day 4

Date Required

Readings in the Morning

Heart rate morning Optional

Systolic morning Required

Diastolic morning Required

Readings in the Evening

Heart rate evening Optional

Systolic evening Required

Diastolic evening Required

Day 5

Date Required

Readings in the Morning

Heart rate morning Optional

Systolic morning Required

Diastolic morning Required

Readings in the Evening

Heart rate evening Optional

Systolic evening Required

Diastolic evening Required

Day 6

Date Required

Readings in the Morning

Heart rate morning Optional

Systolic morning Required

Diastolic morning Required

Readings in the Evening

Heart rate evening Optional

Systolic evening Required

Diastolic evening Required

Day 7

Date Required

Readings in the Morning

Heart rate morning Optional

Systolic morning Required

Diastolic morning Required

Readings in the Evening

Heart rate evening Optional

Systolic evening Required

Diastolic evening Required

Average Reading

These fields will only give an accurate average if you have completed ALL of the systolic/diastolic fields above as the calculation is based on 2 readings per day for 7 days (omitting day 1).

Average Systolic Required

Average Diastolic Required