Blood Pressure Log

Name: ___________________________________________

Date

Time

B.P.

Special circumstances example: exercise, stress, resting

A.M / P.M

Physician Instructions:

Return for follow-up office visit in:

1 week

2 weeks

1 month

Blood Pressure Medication:

Dose:

Frequency:

__________________________________________ ________

_________________

__________________________________________ ________

_________________

__________________________________________ ________

_________________

PLEASE BRING THIS LOG WITH YOU TO YOUR NEXT FOLLOW-UP OFFICE VISIT

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Parent category: Medical