diff --git a/NEWS.md b/NEWS.md
index 40d67881..e810483c 100644
--- a/NEWS.md
+++ b/NEWS.md
@@ -1,4 +1,7 @@
 # odbc (development version)
+
+* SQL Server: Specialize syntax in sqlCreateTable to avoid failures when
+  writing to (new) local temp tables. (@detule, #601)
 * SQL Server: Improved handling for local temp tables in dbWrite, dbAppendTable,
   dbExistTable (@detule, #600)
 * Teradata: Improved handling for temp tables (@detule and @But2ene, #589, 590)
diff --git a/R/db.R b/R/db.R
index 8959a3ca..addb3eeb 100644
--- a/R/db.R
+++ b/R/db.R
@@ -331,3 +331,24 @@ setMethod(
     }
     NROW(df) > 0
   })
+
+#' SQL Server specific implementation.
+#'
+#' Will warn user if `temporary` is set to TRUE but table name does not conform
+#' to local temp table naming conventions.  If writing to a global temp table, user
+#' should not set the temporary flag to TRUE.
+#'
+#' In both cases a simple CREATE TABLE statement is used / the table identifier
+#' is the differentiator ( viz-a-viz creating a non-temp table ).
+#' @inheritParams DBI::sqlCreateTable
+#' @rdname SQLServer
+#' @usage NULL
+setMethod("sqlCreateTable", "Microsoft SQL Server",
+  function(con, table, fields, row.names = NA, temporary = FALSE, ..., field.types = NULL) {
+    if ( temporary && !isTempTable( con, table ) )
+    {
+      warning("Temporary flag is set to true, but table name doesn't use # prefix")
+    }
+    temporary <- FALSE
+    callNextMethod()
+})
diff --git a/man/SQLServer.Rd b/man/SQLServer.Rd
index e80d7d07..1e07c4b9 100644
--- a/man/SQLServer.Rd
+++ b/man/SQLServer.Rd
@@ -7,6 +7,7 @@
 \alias{isTempTable,Microsoft SQL Server,character-method}
 \alias{dbExistsTable,Microsoft SQL Server,character-method}
 \alias{dbExistsTable}
+\alias{sqlCreateTable,Microsoft SQL Server-method}
 \title{Simple class prototype to avoid messages about unknown classes from setMethod}
 \arguments{
 \item{conn}{A \linkS4class{DBIConnection} object, as returned by
@@ -25,6 +26,40 @@ e.g. \code{Id(schema = "my_schema", table = "table_name")}
 \item a call to \code{\link[DBI:SQL]{SQL()}} with the quoted and fully qualified table name
 given verbatim, e.g. \code{SQL('"my_schema"."table_name"')}
 }}
+
+\item{con}{A database connection.}
+
+\item{table}{The table name, passed on to \code{\link[DBI:dbQuoteIdentifier]{dbQuoteIdentifier()}}. Options are:
+\itemize{
+\item a character string with the unquoted DBMS table name,
+e.g. \code{"table_name"},
+\item a call to \code{\link[DBI:Id]{Id()}} with components to the fully qualified table name,
+e.g. \code{Id(schema = "my_schema", table = "table_name")}
+\item a call to \code{\link[DBI:SQL]{SQL()}} with the quoted and fully qualified table name
+given verbatim, e.g. \code{SQL('"my_schema"."table_name"')}
+}}
+
+\item{fields}{Either a character vector or a data frame.
+
+A named character vector: Names are column names, values are types.
+Names are escaped with \code{\link[DBI:dbQuoteIdentifier]{dbQuoteIdentifier()}}.
+Field types are unescaped.
+
+A data frame: field types are generated using
+\code{\link[DBI:dbDataType]{dbDataType()}}.}
+
+\item{row.names}{Either \code{TRUE}, \code{FALSE}, \code{NA} or a string.
+
+If \code{TRUE}, always translate row names to a column called "row_names".
+If \code{FALSE}, never translate row names. If \code{NA}, translate
+rownames only if they're a character vector.
+
+A string is equivalent to \code{TRUE}, but allows you to override the
+default name.
+
+For backward compatibility, \code{NULL} is equivalent to \code{FALSE}.}
+
+\item{temporary}{If \code{TRUE}, will generate a temporary table statement.}
 }
 \value{
 \code{dbExistsTable()} returns a logical scalar, \code{TRUE} if the table or view
@@ -33,7 +68,7 @@ specified by the \code{name} argument exists, \code{FALSE} otherwise.
 This includes temporary tables if supported by the database.
 }
 \description{
-For SQL Server, conn@quote will return the quotation mark, however
+For SQL Server, \code{conn@quote} will return the quotation mark, however
 both quotation marks as well as square bracket are used interchangeably for
 delimited identifiers.  See:
 \url{https://learn.microsoft.com/en-us/sql/relational-databases/databases/database-identifiers?view=sql-server-ver16}
@@ -47,6 +82,10 @@ Local temp tables are stored as
 
 If we can identify that the name is that of a local temp table
 then adjust the identifier and query appropriately.
+
+Will warn user if \code{temporary} is set to TRUE but table name does not conform
+to local temp table naming conventions.  If writing to a global temp table, user
+should not set the temporary flag to TRUE.
 }
 \details{
 True if:
@@ -65,6 +104,9 @@ the table correctly unless name is adjusted ( allowed trailing wildcards to
 accomodate trailing underscores and postfix ).
 
 Therefore, in all cases query for \code{name___\%}.
+
+In both cases a simple CREATE TABLE statement is used / the table identifier is
+is the differentiator ( viz-a-viz creating a non-temp table ).
 }
 \section{Failure modes}{
 
diff --git a/tests/testthat/_snaps/SQLServer.md b/tests/testthat/_snaps/SQLServer.md
new file mode 100644
index 00000000..5a232d17
--- /dev/null
+++ b/tests/testthat/_snaps/SQLServer.md
@@ -0,0 +1,8 @@
+# Create / write to temp table
+
+    Temporary flag is set to true, but table name doesn't use # prefix
+
+---
+
+    Temporary flag is set to true, but table name doesn't use # prefix
+
diff --git a/tests/testthat/test-SQLServer.R b/tests/testthat/test-SQLServer.R
index 2d78174f..71092c71 100644
--- a/tests/testthat/test-SQLServer.R
+++ b/tests/testthat/test-SQLServer.R
@@ -262,4 +262,40 @@ test_that("SQLServer", {
     # Fail because table not actually present
     expect_true( !dbExistsTable( con, tbl_name3, catalog_name = "tempdb" ) )
   })
+
+  test_that("Create / write to temp table", {
+    testthat::local_edition(3)
+    con <- DBItest:::connect(DBItest:::get_default_context())
+    locTblName <- "#myloctmp"
+    globTblName <- "##myglobtmp"
+    notTempTblName <- "nottemp"
+
+    df <- data.frame( name = c("one", "two"), value = c(1, 2) )
+    values <- sqlData(con, row.names = FALSE, df[, , drop = FALSE])
+    ret1 <- sqlCreateTable(con, locTblName, values, temporary = TRUE)
+    ret2 <- sqlCreateTable(con, locTblName, values, temporary = FALSE)
+
+    nm <- dbQuoteIdentifier(con, locTblName)
+    fields <- createFields(con, values, row.names = FALSE, field.types = NULL)
+    expected <- DBI::SQL(paste0(
+      "CREATE TABLE ", nm, " (\n",
+      "  ", paste(fields, collapse = ",\n  "), "\n)\n"
+    ))
+
+    expect_equal( ret1, expected )
+    expect_equal( ret2, expected )
+    expect_snapshot_warning(sqlCreateTable(con, globTblName, values, temporary = TRUE))
+    expect_no_warning(sqlCreateTable(con, globTblName, values, temporary = FALSE))
+    expect_snapshot_warning(sqlCreateTable(con, notTempTblName, values, temporary = TRUE))
+    expect_no_warning(sqlCreateTable(con, notTempTblName, values, temporary = FALSE))
+
+    # These tests need https://github.com/r-dbi/odbc/pull/600
+    # Uncomment when both merged.
+    # dbWriteTable(con, locTblName, mtcars, row.names = TRUE)
+    # res <- dbGetQuery(con, paste0("SELECT * FROM ", locTblName))
+    # expect_equal( mtcars$mpg, res$mpg )
+    # dbAppendTable(con, locTblName, mtcars)
+    # res <- dbGetQuery(con, paste0("SELECT * FROM ", locTblName))
+    # expect_equal( nrow( res ), 2 * nrow( mtcars ) )
+  })
 })