Progressing Minds Professional Referral

Before submitting

Progressing Minds is a private-pay practice and does not participate with insurance plans. We typically respond to referrals within 1–2 business days. This form is not monitored continuously and should not be used for emergencies or urgent concerns.

Person Being Referred

First name

Last name

Phone number

Email address

State of residence

Referral Source

Full name

Phone number

Email address

Role or relationship to person being referred

Practice or organization name

Reason for Referral

Which psychologist are you referring this person to?

Dr. Lizbeth K. Garcia-Bravo Dr. Alexander Quiros No preference / not sure

What service are you referring this person for?

Individual Therapy Group Therapy Psychological Assessment Not sure / Other

Is the person aware of this referral and expecting to be contacted by Progressing Minds?

Yes No

Briefly, please tell us the reason for the referral.

Please include any information you think would be helpful in determining whether our services may be a good fit.

Supporting Documents

If relevant, you may securely attach supporting documents such as evaluation reports or other records.

Supporting documents

Add file

Please upload a file

Important Information

Submitting this referral does not establish a professional relationship or guarantee availability.

This form should not be used for emergencies or urgent concerns.

Your information will be encrypted.

Progressing Minds Professional Referral

Before submitting

Person Being Referred

Referral Source

Reason for Referral

Supporting Documents

Important Information

Before submitting

Progressing Minds, PLLC