Dr Cole & Partners
Blackfield Health Centre
Online Prescription Request
BP Reading Form
To submit a home BP Reading, please complete and submit the form below.
Which surgery are you registered at?
Home Tel Number
Do you wish to receive text messages from us?
Do you wish to receive emails from us?
Date of Birth
Blood Pressure Reading
Please tick this box before submission to acknowledge that this form is being sent un encrypted via the world wide web
If you are not happy to tick the box above please drop your BP reading into the surgery.
Do you drink alcohol?
If yes, how much do you drink a week?
RED & GREEN PRACTICE
Waterside & Blackfield GP Surgery