Lakeside Medical Member Registration

Use the form below to register as a member with Lakeside Medical Group. All information will be handled confidentially within a HIPPA compliant system. There are no costs to 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.

Insurance Card Front
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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.

Insurance Card Back
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(Back of Card) Please scan or take a picture of the back of your insurance card and upload it here.

First Name(*)
Please type your full name.

Last Name(*)
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E-mail(*)
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Phone(*)
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Insurance Carrier(*)
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Policy/Member ID(*)
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Policy Number or Member ID

Date of Birth(*)
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Please click the calendar icon and then click the Month/Year to easily enter your birth month and year

Other policy Information
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Address in Mexico
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How should we contact you?

Are you a Human?(*)
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