New Patient Form


Save time when you come for your initial consultation!

Download the New Patient Health History form. The form is now fillable, and returning it by e-mail is preferred. It can also be printed and brought with you to your scheduled appointment if for some reason it cannot be e-mailed back to us.

New Patient Health History Form – Dr Thelin

 

Lab Request Forms: Below are two lab request forms. You have two options. The first one is for getting the lab work done at Dilabim (in Plaza Interlago on west end of Libramiento – map is included with the file). I use Dilabim for most of my lab work. The second option is for getting the work done at Chopo Labs (this form is for the isiLab in Ajijic – map is included). Both Dilabim and Chopo offer a similar package for a great price. For about $800 pesos, they both include a general urine exam, white and red blood cell count, platelets, bilirubin, full lipid panel (cholesterols and triglycerides), liver enzymes, renal function (creatinine, urea, BUN), uric acid, C-reactive protein, iron levels, electrolytes (calcium, sodium, potassium, chloride, phosphorous, magnesium), glucose, and albumin.  It is recommended to have 7 hours fasting before the test. Anyone not knowing their blood type may also want to additionally check the box that says, “Grupo Sanguineo y Factor Rh”.

http://drsamchapala.com/wp/wp-content/uploads/2016/08/Lab-Request-Dilabim.pdf

http://drsamchapala.com/wp/wp-content/uploads/2016/08/Lab-Request-isi-Lab-Chopo.pdf