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Rainham and Upminster Medical Centre NHS GP surgery in Essex

Blood pressure readings

Blood pressure readings

Which surgery are you registered at? *

Rainham Health Centre

Upminster Medical Centre

Smoking

Smoking status: *

Smoker

Never smoked

Ex smoker

Smoker

What do you mainly smoke?

Cigarettes

Cigars

Rollups

Pipe

E Cigarettes

How many cigarettes do you smoke in a day? *

1 to 9

10 to 19

20 to 39

40 or more

How many cigars do you smoke in a day? *

1 to 9

10 to 19

20 to 39

40 or more

Rollups – How many grams of tobacco do you smoke per week? *

Pipe – How many grams of tobacco do you smoke per week? *

Would you like to give up smoking? *

Yes

No

If you would like help or advice to stop smoking, please visit NHS Quit Smoking.

Ex smoker

What did you mainly smoke?

Cigarettes

Cigars

Rollups

Pipe

E Cigarettes

How many cigarettes did you smoke in a day? *

1 to 9

10 to 19

20 to 39

40 or more

How many cigars did you smoke in a day? *

1 to 9

10 to 19

20 to 39

40 or more

Rollups – How many grams of tobacco did you smoke per week? *

Pipe – How many grams of tobacco did you smoke per week? *

When did you quit smoking? *

Your blood pressure

Please provide a minimum of 1 blood pressure reading, up to a maximum of 7 readings.

Day 1

Date:

Please use this date format: DD/MM/YYYY

Morning Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Evening Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Day 2

Date:

Please use this date format: DD/MM/YYYY

Morning Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Evening Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Day 3

Date:

Please use this date format: DD/MM/YYYY

Morning Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Evening Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Day 4

Date:

Please use this date format: DD/MM/YYYY

Morning Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Evening Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Day 5

Date:

Please use this date format: DD/MM/YYYY

Morning Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Evening Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Day 6

Date:

Please use this date format: DD/MM/YYYY

Morning Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Evening Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Day 7

Date:

Please use this date format: DD/MM/YYYY

Morning Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Evening Measurement

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Average blood pressure

This is automatically calculated for internal use only.

Morning Measurement

Average morning systolic

Average morning diastolic

Average morning heart rate

Evening Measurement

Average evening systolic

Average evening diastolic

Average evening heart rate

Terms and conditions *

I confirm that this is not an emergency and understand the surgery cannot help while it is closed. If I need help right now, I will use the NHS 111 service. In an emergency, I will call 999 or go to A&E.

If you are human, leave this field blank.

Rainham Health Centre
Upminster Road South
Rainham
RM13 9AB

Get directions

01708 796579

Upminster Medical Centre
224 – 226 St Mary’s Lane
Upminster
Essex
RM14 3DH

Get directions

01708 251407

About the surgery

Register with the surgery

Sick (fit) notes

Feedback and complaints

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