Referrals

Make a Referral

Looking for therapy or referring someone to the practice? Choose the option below that best fits what you need.

Choose what you need

How can we help?

People seeking therapy for themselves, a child, a family member, or a relationship can request an appointment. Professionals, schools, agencies, case managers, and community partners can use the referral options for Prickly Pear Therapy. If you are unsure which path applies, ask the practice for help.

Printable option

Complete a blank referral form

Open the blank form, print and complete it, then return it using one of the approved methods listed below.

Open or Print Form Download Blank PDF

Return the completed form

Return by fax

Fax the completed referral form to 505-213-5320. Verify that you entered the number correctly before sending. Use a confidential cover sheet when appropriate.

Bring it to the office

Deliver the completed form during normal office hours or at a scheduled appointment. Call before arriving if you need to confirm when someone will be available to receive it. 1740 Grande Blvd SE, Rio Rancho, NM 87124

Please note: Do not email a completed referral form or include private health information in an ordinary website message.

Preview the blank formThe preview is blank and contains no client information.View preview

Referral questions

Need help with a professional referral?

Use this form only for an administrative question about the referral process. Do not include a client’s name, diagnosis, insurance information, treatment history, records, or other private health information.

Your name * Your email * Your phone You are contacting us as What do you need help with? * Organization or agency Preferred contact

Need immediate help?

This page is not for emergencies

Call 911 or 988 in the United States when immediate help is needed. For an ordinary administrative question about the referral process, contact the practice directly.

Call (505) 808-9059 →