By signing this document, you acknowledge and agree to the following policies and procedures established by Creative Medical Consulting, LLC.
1. Care Coordination
We strive to provide personalized, holistic care. By consenting to treatment, you authorize Creative Medical Consulting, LLC to collaborate with other members of your healthcare team as necessary to support optimal treatment outcomes.
2. Appointment Cancellation Policy
· A minimum of 48 hours notice is required for appointment cancellations.
· Cancellations made within 48 hours are subject to a $75 late cancellation fee.
· For Monday appointments, cancellations must be made by close of business on Thursday to avoid a late fee.
· Two missed appointments or late cancellations may result in discharge from the practice.
3. Medication Refills & Management
· Refill requests require 48 hours processing time.
We are happy to send in your refills at your request however we DO NOT accept refill requests from pharmacies
· Requests may be submitted via:
Email: office@creativemedicalde.com
Phone: 302-313-1411
· You will only be contacted if clarification is needed.
· Medication changes require an appointment and will not be handled by phone.
4. Documentation & Forms
· Disability, FMLA, and other official documents are completed case-by-case for established patients only.
· A $25 fee applies and must be paid prior to completion.
· Documentation for legal, employment, or court purposes:
Will not be completed at the initial visit
May require multiple visits for appropriate evaluation
5. Controlled Substance Policy
Patients prescribed controlled substances agree to the following:
· Participation in random drug screening as requested
· Use of one designated pharmacy unless discussed with provider
· No early refills for lost, stolen, or misplaced medications
· Notify the practice of any controlled substances prescribed by other providers
· Take medications exactly as prescribed
Non-compliance may result in immediate discharge, including:
· Failure to complete drug screening
· Unauthorized dose changes
· Evidence of misuse or diversion
Additional terms:
· Falsifying symptoms to obtain controlled substances is a felony offense and may be reported to the DEA
· Neuropsychological testing may be required prior to initiating stimulant therapy
· Controlled substances will not be prescribed with illicit drug use, including marijuana
6. Crisis & Emergency Care
Creative Medical Consulting, LLC does not provide emergency or crisis services.
In the event of a crisis:
· Call 911 or Mobile Crisis: 1-800-985-5252
Additional resources:
· Meadowood Hospital: 302-328-3330
· Rockford Center: 302-996-5480
· Wilmington Hospital CAPES: 302-733-1000
· Dover Behavioral Health: 302-741-0140
7. Insurance & Payment Responsibility
· Insurance is a contract between you and your insurer.
· Creative Medical Consulting is not a party to that contract.
· By signing, you assign benefits to be paid directly to the practice.
Patient responsibilities:
· Payment of co-pays, deductibles, and out-of-pocket costs are due at time of service
· Awareness of your insurance coverage prior to visits
· Deductibles may require payment prior to claim submission
· Patients with an outstanding balance exceeding $250 who are not enrolled in an approved payment plan will not be scheduled for future appointments until the balance is resolved.
8. Treatment of Minors
· Patients under 18 must be accompanied by a responsible adult at the initial visit
· Follow-up visits may occur without a parent if written consent from legal guardians is on file
9. Respectful Conduct
Creative Medical Consulting, LLC maintains a respectful, inclusive environment.
· Disrespectful or inappropriate behavior toward staff will result in discharge from the practice.
10. Agreement & Authorization
By signing below, you acknowledge that:
· You have read and understand this policy
· You have received the HIPAA Notice of Privacy Practices
· You authorize release of necessary information to your insurance carrier
· You accept responsibility for payment and applicable fees
· You understand this agreement automatically renews annually unless revoked in writing
