Please complete the following form to request authorization of follow-up visits and/or procedures to be funded on a Red Rock lien or LOP. Multiple treatment types can be selected in one submission, such as 1. Surgery Center (facility charges), 2. Anesthesia, 3. Ortho/Spine.
Step 1: Fill out the form below to include cost estimate.
Step 2: Attach the clinical notes and Red Rock intake form from initial patient visit, if applicable.
Step 3: Submit