Submit a Single Blood Pressure Reading

If you have been asked to submit a blood pressure reading to Moatfield Surgery, please use this form. 

 

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Personal Details

Please fill in your personal details so we can match your readings to your medical record.

Please double check you've entered the correct email address
 
 
Smoking Status

Please provide one blood pressure reading.

 
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Your Blood Pressure Day 1
 
 
Your systolic blood pressure is the top number on your reading
Your diastolic blood pressure is the bottom number on your reading
Your pulse rate is the number of times your heart beats per minute
 
   
   
 

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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