Records Request - Red Rock Diagnostics

Record Request

Welcome to the Red Rock Records Portal. Please complete the form below to submit a request for records and bills. If you need an Affidavit completed with your Records Request, please upload at the bottom of the form. If you are a third party, please upload the patient-signed HIPAA Release form with your request, and the attorney’s affidavit, if needed.

Injured Party Information

First Name

Last Name

Date of Accident

Date of Birth

Requested Documents

Attorney Information

Firm Name

Contact at Firm

Phone

State

Is the Requesting Party different from the Attorney?

Requesting Party Information

Requesting Party

Requesting Party Contact Name

Requesting Party Phone

Requesting Party Email

Please upload the client signed HIPAA form here, or fax to: 702-362-5132

Please upload the referral/affidavit form here, or fax to: 702-362-5132

SUBMIT FORM VIA EMAIL OR FAX TO:

records@redrockdiagnostics.com

Fax: (702) 362-5132

Questions? Call us at (877) 362-6077

Red Rock Diagnostics, LLC ∙ P.O. Box 26119 Las Vegas, NV 89126

Contact Information