Patient Forms

Save time when you come for your initial consultation!

Download the Patient Health History form. The form is now fillable. It is a pdf you can open on your computer, complete, and save changes so it can then be returned to us by  e-mail. 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. Make sure it is opened in an actual pdf program, and not just in a web browser. It is  an interactive document, and most web browsers attempting to read pdf pages will not allow the interactive features of the document.

Click to download the Patient Health History Form.

Lab Request Forms

Below are several lab request forms. 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).  The second form is for getting the work done at Chopo Labs (this form is for the Chopo at  isiLab in Ajijic – map is included). The third form is for BestLab which has the advantage of doing most of the labwork here locally instead of sending it to Guadalajara, making them an important lab in case of an emergency (thus, they deserve our support).  Chopo beside Clinica Maskaras is also good, as is GoLabs labs next door to it. Dilabim, BestLab, and Chopo offer a similar package for a great price. For about $850 pesos, they  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”. The lab forms have been made interactive so you can add your name (and e-mail address if you also want the results sent to you) before printing them so they will be clearer to read.

Lab Request – BestLab

Lab Request – Chopo isiLab

Lab Request – Dilabim

Lab Request – Chopo – main

In Case of Emergency (ICE) cards

We have made this card available to everyone regardless of who your doctor is or where you live. These are designed for English speaking people living in a Spanish language country. By clicking the above red text, it will open an interactive pdf document so you can type your information on the card. Then print it on a regular 11″ x 8.5″ letter-sized sheet of  paper. Cut the card out of the middle, fold, and ideally laminate to protect it. Full instructions on how to make the best of this card can be found here.