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.

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E-mail* Invalid email address.	Phone* Invalid Input
Insurance Carrier* Invalid Input	Policy/Member ID* Invalid Input Policy Number or Member ID
Date of Birth* Invalid Input Please click the calendar icon and then click the Month/Year to easily enter your birth month and year	Other policy Information Invalid Input
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Member Registration

First Name*

Last Name*

E-mail*

Phone*

Insurance Carrier*

Policy/Member ID*

Date of Birth*

Other policy Information

Address in Mexico

How should we contact you?

Insurance Card Front

Insurance Card Back

Gov Issued ID Front

Gov Issued ID Back

Are You Human?*

Lake Chapala - Ajijic, Mexico

Toll Free Phone Numbers