Intake Forms

Save time before your first appointment! Please complete the following simple intake forms and bring them with you. We will also need a copy of your photo ID, and copies of medical insurance cards, if applicable, so please bring these with you.

If any of your information changes after your initial form is on file, please fill out a new form and update any relevant information. In order to make life a bit simpler, we have forms that you can actually fill out online.

Instructions:

Simply fill out your form, print, and send to us via e-mail or bring them with you when you next visit.

Any completed forms may be sent to nurses@lakesdermatology.com

Downloads:

Medical Records

If you need copies of your medical records, please fill out this request form and mail or fax to us. We will let you know if a fee applies before we send any records.

Downloads:

Please read our 2024 No Show and Cancellation Policy.

 

Happy Patient

I am a happy patient of Dr. Rueckl.  I have had Fractora several times.  Couldn’t be happier.
– S.P.

 

Hi everyone at Lakes Dermatology!!!

Wanted to say “Thank You” to everyone for helping me look my best for my competition this past Saturday July6th.
I WON!!! Took first place ? on both of the categories I competed and took overall on both which I broke record, no-one has won 2 overalls in one show.
Thank you ??
SM

 

I Love This Place!

I love this place. My first step in their office, I was like, whoa! It’s beautiful! I was sent here by the VA for some skin issues and the doctors here are truly amazing. He listens to every single complaint I’ve had without any judgment and is very positive about my treatment plan! Even the nurses and ladies behind the desks were super friendly. I definitely recommend this place!!

 

Does The Best Lips!

Does the best lips! He’s also a really skilled injector. I don’t even think he numbed me, but I barely felt anything. It was nice not to do a dental block. He gave me the exact (natural) look I was going for. Not obviously fake at all but I DID get compliments on my lips from a few of my doctor friends!

 

The Best Doctor Ever!

The best Doctor ever! I’ve been dealing with rosacea for years and he was the only doctor who really help me. Im really glad that i find this amazing person he’s so kind, professional humble

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