NHS Registration > Blood Pressure Check Request Blood Pressure Check Request Eligibility ScreeningRequired before booking.Are you aged 40 or over?(Required) Yes No Have you been diagnosed with high blood pressure (hypertension)?(Required) Yes No Have you had your blood pressure checked by a healthcare professional in the last 6 months? Yes No Reason for appointment NHS Blood Pressure Check Private Blood Pressure Check GP Referral Patient DetailsFull Name(Required)Enter your full legal name.Date of Birth(Required) DD slash MM slash YYYY Your date of birth is required to verify you are over 18 and eligible for treatment.Email Address(Required) We will use this email address to send consultation updates and treatment information.Phone Number(Required)A pharmacist may contact you if further clinical review is required.Appointment RequestPreferred Appointment Date(Required) DD slash MM slash YYYY Select a preferred date to visit the pharmacy.Preferred Time of Day(Required) Morning Afternoon Anytime GP Details and ConsentGP Practice NameEnter the name of your GP surgery if known.GP Practice PostcodeEnter the postcode of your GP surgery if known.Consent to contact my GP if needed(Required) Yes No I consent to the pharmacy contacting my GP practice if needed to support my consultation or treatment review. ! Warning — Please Read GP notification recommended We recommend informing your GP for continuity of care. A clinician may discuss this with you. DeclarationsInformation Accuracy(Required) I confirm my information is accuratePlease ensure all details are correct before submitting.Blood Pressure Check Consent(Required) I consent to this consultationI consent to the pharmacy reviewing my information and carrying out a blood pressure check as part of this service.Privacy Policy(Required) I agree to the Privacy PolicyPlease review how we collect, use and protect your personal data.CAPTCHA What to expect Complete this appointment request so our pharmacy team can review your details and arrange your blood pressure check.Confirmation email sent after submissionReviewed by our pharmacy teamAppointment confirmed by email Next steps 1Complete the blood pressure check form 2Check your email for confirmation 3Our pharmacy team reviews your request 4We confirm your appointment by email