Patient Forms

Please complete a Patient History Form and return it by e-mail before 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.  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  Chopo Labs (this form is for the Chopo at  isiLab in Ajijic – map is included). The second form is for the Chopo lab  beside Clinica Maskaras.  The third form is for BestLab which is a smaller independent lab in Riberas.  The fourth one is for Dilabim (in Plaza Interlago on west end of Libramiento – map is included with the file). Dilabim and BestLab offer a similar 35-element 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 (except BestLab), iron levels, electrolytes (calcium, sodium, potassium, chloride, phosphorous, magnesium), glucose, and albumin.  Chopo labs offer a 45-element package for only a few pesos more that includes more detail on several items, and it includes an IgG, IgM, and IgA antibody count. 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 – Chopo isiLab

Lab Request – Chopo – main

Lab Request – BestLab

Lab Request – Dilabim

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.