Submit a Referral

Requesting Party (Please fill out the form completely)







Injured Party Information











Requested Procedure Information







A physician script attachment is required because the treatment requested is Imaging.

If you have trouble with this form or need to contact us directly:

scheduling@redrockdiagnostics.com

Phone: (833) 277-7625 / Fax: (702) 202-2052

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