Welcome!
It is our pleasure to welcome you to our
office. We are committed to helping you
and your family achieve the greatest improvement for
your child, through the most recent biological, medical, and nutritional
advances.
Please make a note of
the date and time of your child’s first appointment:
Scheduled for ___________________________________ @ _____________ with:
□ Dr. Bradstreet □
□ Office Appt. in □
Melbourne (Map) or □ California (Map) OR □ Phone Appt.
For office appointments, please arrive 15
minutes before your scheduled time. For
phone appointments, please call our office a few minutes before your scheduled
time.
Due to the variability of insurance benefits,
we are unable to bill insurance for you. We will however, assist you by providing
invoices with coding and HCFA forms as needed, by
request. You are responsible for payment for all services, and payment is due
when services are rendered.
If you haven’t already done so, we encourage
you to start your child on a gluten free/casein free
diet. We see the most significant
improvements in our patients who are on the GF/CF diet. We recommend the following resources:
1.
Facing Autism by Lynn Hamilton
2. Special Diets for
Special Kids by Lisa Lewis
Below is a list of documents provided to give you
important information about your child’s treatment. Print them out, read them carefully, and save
for your records.
Notice of Privacy Practices (HIPAA)
Appointment Cancellation Policy
|
The following forms must be completed and returned to
our You will forfeit your appointment if these forms are
not received. * Patient Consent for Use and Disclosure
of Protected Health Information * Limited Authorization for Communication
of Protected Health Information * Consent for Treatment for Minors
or Consent for Treatment for Adults
(whichever
applies) |
Cont.
The following medical records and documents
must reach our
□
Any lab results related to the reason for the
appointment
□
Immunization Record
□
EEG, QEEG or MRI Records (no films, just the report)
□
Hospital Records (only for hospital stays related to the reason for the
Appointment)
□
Original diagnosis
□
Recent evaluation(s) either by a doctor,
school, or therapist
□
Copy of Insurance Card, both
sides, for outside lab referrals
□
The forms noted above with an *.
Please do not send us
originals or your only copies.
|
Mail (No Emails; no faxes) all documents to
the following address: Creation’s Own, Corp® Attention: Medical
Records Department NOTE: All records must be mailed to our |
We are looking
forward to working with you to improve your child’s health and well-being.
Sincerely,
Creation’s Own Staff
