Injured Party Information

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    Requested Procedure Information:


    Imaging Physical Therapy Chiropractic Orthopedic Neuro Pain Management
    ExtremitySpine

    Please upload the signed physician referral form here, or fax to: 702-463-4259

    Maximum upload file limit is 25MB

    Please upload the Patient-signed Red Rock Lien or LOP and Health Insurance Waiver.

    SUBMIT FORM VIA EMAIL OR FAX TO:

    scheduling@redrockdiagnostics.com

    Fax: (702) 463-4259

    Questions? Call us at (877) 362-6077

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