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Patient intake
Patient intake
Five steps, about ten minutes. At the end you get a printable summary with your history, your travel dates and the therapies you are interested in.
What you type here does not leave your browser
This form sends nothing to any server. Everything happens on your computer or your phone, and at the end you get a summary you can print or save. If you close the tab without printing it, the information is gone and no copy remains anywhere. You decide whether to bring it to the consultation or not hand it over at all.
Patient intake · BMC Clinic
Your intake summary
Printed or on screen, bring it to the consultation. If you would rather send it ahead, email it from your own mailbox.
Av. Gral. Ferreira 3170, suite 3170-D, Col. Madero Sur, 22046 Tijuana, B.C.
How to hand it in
Printed, at the consultation
The simplest route and the one that exposes your data least. Print it and bring the page.
By email, from your mailbox
Copy the summary and paste it into an email of your own addressed to the clinic. That way it is sent from your account and you keep the copy.
On WhatsApp, just to let us know
Message the clinic to say your form is ready. Do not paste your medical history into the chat: the summary goes printed or by email.