Lakeside Medical Group

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.

First Name*

Please type your full name.
Last Name*

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Insurance Carrier*

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Policy/Member ID*

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Date of Birth*

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Other policy Information

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Address in Mexico

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How should we contact you?

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Insurance Card Front

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Insurance Card Back

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Gov Issued ID Front

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Gov Issued ID Back

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Are You Human?*
Are You Human?

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