F. Victor Rueckl, MD - Lakes Dermatology & The Spa at Lakes Dermatology
   Call us:  1.702.869.6667

Patient Forms






Intake Forms

If you would like 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 on line. Simply fill out your form, print, and send to us via mail or bring them with you when you next visit.


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.


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Our Offices

Lakes Dermatology
8861 W. Sahara Ave., Suite 290
Las Vegas, NV 89117
Phone: (702) 869-6667

The Spa at Lakes Dermatology
8861 W. Sahara Ave., Suite 190
Las Vegas, NV 89117
Phone: (702) 341-7546 (SKIN)

Contact Form

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