Blood Pressure Eligibility Upload – Apple Study

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First name

Last name

DOB

Month

Day

Year

Phone

Record your blood pressure reading as shown on your document or image below. Then upload your file.

Systolic Reading

Diastolic Reading

Upload a medical record or picture of your blood pressure reading. The image must clearly show systolic and diastolic numbers (eg. 140/90). For images, please ensure your photo ID is in the image, next to the blood pressure reading.

I voluntarily submit this blood pressure reading for eligibility confirmation for a research study and understand it will be reviewed by Renew Health Clinical Research.

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