Clearwave Message Our Care Team

Message Our Care Team

Please do not use this form for emergencies or urgent medical concerns. This secure form is reviewed by our care team during business hours and
Patient Information
Patient Name

First NameLast Name
Patient Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Patient Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Patient Email Address
example@example.com
Preferred Contact Method

Location / Provider
Clearwave Location
Clearwave Provider
Reason for Message
What can we help you with?
For appointment changes, cancellations, rescheduling, or if you are running late, please text our front office team directly at 845-484-8900.

This form is not the fastest way to reach us for appointment-related issues.
Message Details
Please describe how we can help.
Medication-Specific Questions
Medication Name
Medication Dose (if known)
How are you taking this medication?
Pharmacy Name and Location (if relevant)
Any allergies or reactions to medication?
Upload any relevant documents or photos (Optional)

You may upload forms, insurance documents, medication labels, outside records, or photos if relevant.
Cancelof
Acknolwedgment

I understand this form is for non-urgent messages only and is reviewed during business hours. I understand this form should not be used for emergencies, urgent medical concerns, severe medication reactions, suicidal thoughts, or time-sensitive issues. If this is an emergency, I will call 911 or go to the nearest emergency room. If I am in crisis or having thoughts of self-harm, I will call or text 988.
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Message Our Care Team