Invoice Request | Grupo Médico Costamed

To make your experience even more convenient, we have created a specialized form for you to request the corresponding invoice for the services acquired. Please fill in the required information carefully. Your request will be forwarded to the finance department for processing. If you have any questions, please contact us at 800 900 1133 or email us at info@costamed.com.mx.

Select the service you want:

Applicant details

Hospital*

First Name*

Last Name*

Email*

Phone*

Reference number (Number printed on your physical note. It may appear as REMISION in the upper left corner, in black color, or as No. in the central part, in red color.)

Amount

Is the patient requesting?

Patient full name*

Relationship with the patient*

Service date* (For hospitalizations enter the date the patient was admitted.)

Previous invoice number*

Business name* Identical to how it appears in your Fiscal Situation Certificate

Zip Code* Identical to how it appears in your Fiscal Situation Certificate

RFC* Identical to how it appears in your Fiscal Situation Certificate

Tax regime* Identical to how it appears in your Fiscal Situation Certificate

CFDI use*

Reason for re-invoice / cancellation*

Address

Neighborhood

City

State