Find a Provider

Red Rock works with physicians and providers in 28 states to fund medical treatment on a lien or LOP basis. Utilize the form below for assistance in locating a medical provider that will accept a lien or letter of protection. If you have questions, please feel free to reach out to us: findaprovider@redrockdiagnostics.com / 980-800-6991.

Requesting Party (Please fill out the form completely)

Provider Name

Point of Contact

State

Phone

Fax

Injured Party Information

First Name

Last Name

Date of Accident

Date of Birth

Phone

Cell Phone

Address	City
State	Zip Code

Attorney Information

Attorney Firm Name

Point of Contact

State

Phone

Fax

Requested Procedure Information

Treatment Request

Diagnosis/Symptoms

Provider or Facility Requested

Please upload the physician script here.

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

Additional Notes

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

findaprovider@redrockdiagnostics.com

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

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

Contact Information