Request an Appointment

Please download and complete the following forms prior to your first appointment:

* New Patient Intake Form (Download)
* Chapala Med Forms (English)

For our patients who prefer to pay fees and honoraries by Credit Card, we offer you the ONLINE PAYPAL PAYMENT OPTION.



Patient Records

The Medical Records Release Form will be used if Chapala Med is coordinating your care or referring you to another physician who may need access to your medical records.

EMR - Chapala Med

All medical records are in EMR (ELECTRONIC MEDICAL RECORD) format that you will be able to have online access to and our records are compliant to U.S. HIPPA LAWS and are not share with anybody who does not have a clear criminal record with Mexican or U.S./Canadian authorities. This is done in order to protect your private confidential information from identity theft or fraud.

This is done in order to protect your private confidential information from identity theft or fraud. Your medical and personal information is not shared with insurance companies or other health care providers without your prior authorization.

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