My Blood Pressure Log



PATIENT INFORMATION

First Name*:

Last Name*:

Date of Birth*:

My Blood Pressure Goal:



mm Hg

Gestational Age:

Medications:

INSTRUCTION:

  • Measure your blood pressure twice a day- morning and late afternoon- at about the same time every day.
  • For best results, sit comfortably with both feet on the floor for at least two minutes before taking a measurement.
  • When you measure your blood pressure, rest your arm on a table so the blood pressure cuff is at the same height at your heart.
  • Record your blood pressure on this sheet and email/fax it to the email/fax number provided below.


DATE

AM

PM

* = Input is required