New Patient Forms

Save time when you come for your initial consultation!

Download the New Patient Health History form. The form is now fillable, and returning it by e-mail is preferred. It can also be printed and brought with you to your scheduled appointment if for some reason it cannot be e-mailed back to us.

Click to download the New Patient Health History Form.

Lab Request Forms

Below are two lab request forms. You have two options. The first one is for getting the lab work done at Dilabim (in Plaza Interlago on west end of Libramiento – map is included with the file). I use Dilabim for most of my lab work. The second option is for getting the work done at Chopo Labs (this form is for the isiLab in Ajijic – map is included). Both Dilabim and Chopo offer a similar package for a great price. For about $800 pesos, they both include a general urine exam, white and red blood cell count, platelets, bilirubin, full lipid panel (cholesterols and triglycerides), liver enzymes, renal function (creatinine, urea, BUN), uric acid, C-reactive protein, iron levels, electrolytes (calcium, sodium, potassium, chloride, phosphorous, magnesium), glucose, and albumin.  It is recommended to have 7 hours fasting before the test. Anyone not knowing their blood type may also want to additionally check the box that says, “Grupo Sanguineo y Factor Rh”.

Lab Request – Dilabim

Lab Request – Chopo