Please complete the following form to request authorization of follow-up visits and/or procedures to be funded on a Red Rock lien or LOP.
Step 1: Fill out the form below to include cost estimate.
Step 2: Attach the clinical notes and Red Rock intake form from initial patient visit, if applicable.
Step 3: Submit.
Please include the patient-signed 2-page Red Rock Intake
Form and/or clinical notes, if applicable.
Red Rock Diagnostics, LLC ∙ P.O. Box 26119 Las Vegas, NV 89126