Melissa Young, MD FACE FACP
Saima Farghani, MD FACE
555 Iron Bridge Road, Suite 18
Freehold, NJ 07728
Tel: 732-409-MADE (6233)
For new patients:
Thank you for considering Mid Atlantic Diabetes and Endocrinology Associates to be part of your health care team.
Please complete the following forms:
Patient registration form (2 pages)
Patient history form
Medication list/allergy list/pharmacy info
Privacy Practices receipt (HIPAA policy receipt)
Practice Policy receipt – you may review our policies here or you may request a copy
Also, have your physician complete a Request for Consultation and have him/her send us a copy of your most recent visit notes and the results of any labs or imaging studies (ultrasounds, bone density tests, MRIs, etc) that may be relevant to your consultation.
Once your information is complete, we will determine if an endocrine consultation is warranted and, if so, will call you to schedule an appointment. We may recommend that your referring physician conduct further testing or start therapy while you await your appointment.
Patients with incomplete information will not be given an appointment.
If we are unable to accommodate you in a timely manner, we will contact your physician with our recommendations.
Patients who miss their initial appointment without giving us at least 24 hours notice will not be rescheduled without a new request for consultation and updated information from the referring physician.