Internal Messaging
At JADE Wellness Center, we understand the importance of timely communication with your medical provider. If you have a non-urgent question, need to request a medication adjustment, need assistance with a prior authorization or would like to follow up on your treatment, please complete the form below.
Please allow up to 72 hours for your request to be triaged.
Patient Information
Patient Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date of birth
Patient Email
example@example.com
Patient Phone Number
*
I agree to allow JADE Wellness Center to contact me?
Yes
No
By submitting this form via this web portal, you acknowledge and accept that risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold JADE Wellness Center harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.
*
Yes
JADE Wellness Center Location
Please Select
Monroeville
Southside
Wexford
Bloom Mental Health
Select your medical provider
Dr. Shannon Allen
Kate Savit
Rosemary Tritschler
Maria Wunderly
Hannah Densford
Gloria Menotiades
Nicole Dolan
Other
Pharmacy Name:
Pharmacy Phone Number
Please enter a valid phone number.
Please provide details for your medical provider regarding your inquiry below.
Submit
Should be Empty: