Repeat Prescriptions

Warning
This form sends information via Internet e-mail to the Surgery. Internet e-mail is not secure and if you are unhappy about sending the information over unsecure e-mail then please do not use this service.

Please complete the following form and click submit and your repeat prescription request will be sent to Springwood Surgery.

Your Surname 

Date of Birth 

Daytime Contact Number 

Pharmacy to be collected from Pick up at Surgery Co-op Boots (Rectory Lane) Boots (Westgate)

Drug Name	Qty	Strength	Dosage

If you get a precondition failed error message when you submit the form this is an error with your ISP (Internet Service Provider). Unfortunately there is nothing we can do about this.