Application For Membership - Lakeside Medical Group

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info@lakemedicalgroup.com

Application For Membership
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Application for Membership


Use the form below to apply for membership with Lakeside Medical Group. All information will be handled confidentially within a HIPPA compliant system. There are no costs to apply or join Lakeside Medical Group. As a member you would have access to our entire hospital and doctor network in Mexico. However your benefits and coverage with us are based on the policy benefits of your existing US or Canadian medical insurance or health plan.

Patient members of our medical group are not responsible for deductibles or co-insurance.

Thank you for your interest. You can apply for membership on this page or you can come into our office in Lake Chapala. The following form is for applying for membership with Lakeside Medical Group. 

1) Please submit you info below

2) Our support dept will review your info

3) If your application for membership meets our criteria then we will contact you with the required documents to complete and secure your membership spot. 

4) A separate application is required for each person in a household

 


Please type your full name.

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Please enter Numeric value . Spaces and special characters (",",".","_","()","[]","-") are not allowed.

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Policy Number or Member ID
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Please click the calendar icon and then click the Month/Year to easily enter your birth month and year OR simply type your date of birth in m-d-Y format
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Please select your country of address.

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(Front of Card) For your convenience and faster processing, please scan or take a picture of the front of your insurance card and upload it here.

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(Back of Card) Please scan or take a picture of the back of your insurance card and upload it here.
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Please enter the number you see into the field below and then press submit
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You can apply for membership above or you can come into our office in Lake Chapala. The form above is for applying for membership with Lakeside Medical Group. 

An application does NOT guarantee you membership. All applications are reviewed and if you are eligble for membership we will contact you. There are no costs to apply and there are no membership fees. There are no hidden charges. 

 

In order to provide the highest of medical standards meeting the AMA (American Medical Association) Standards of Care we can only accept a limited number of memberships in each area of Mexico or Panama. 

 

Currently we are accepting new member applications in the following areas:

Guadalajara

Lake Chapala-Jocotopec and Aijijic

San Carlos Sonora

San Felipe Baja Ca

Rocky Point

Tepatitlan

Zapopan

 

Wait List Areas

We are accepting new member applications in the following areas however all new membership applications are put on an 4 to 10 week wait list  and we are filling spots on a first come-first served basis. As spots open up in your specific area we will let you know when a spot is available for you.  

 

Bucerias

Cancun

Ensenada

Mazatlan

Merida

Panama City, Panama

San Miguel de Allende

Our membership spots are completely filled in the following areas:

 

Los Cabos

Mexico City

Nueva Vallarta

Puebla

Puerto Vallarta

Todo Santos

 

There are currently NO More spots available in these areas. This is subject to change so please feel free to check back with us occasionally. 

 

 

 

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