Record Request
Welcome to the Red Rock Records Request form. Please complete the form below to submit a request for records and bills.
Injured Party Information
First Name
Last Name
Date of Accident
Date of Birth
Requested Documents
Please select...
Billing
Medical
Total Request
Attorney Information
Firm Name
Contact at Firm
Phone
Email
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
PR
VI
GU
AS
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 attach any required forms here, or fax to: 702-362-5132
If you have trouble with this form or need to contact us directly:
records@redrockdiagnostics.com
Phone: (833) 277-7625 / Fax: (702) 202-2052
Red Rock Diagnostics, LLC ∙ P.O. Box 26119 Las Vegas, NV 89126
Contact Information