Referral Forms

Take the first step in your recovery by contacting us today to schedule an initial consultation.

Patient Information

Referral Information

Procedures & Consultations

Orthognathic Eval.
Facial Reconstructive
Sleep Apnea
Cosmetic
TMJ
Oral / Facial Lesion
Other

Teeth

Adult Teeth

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Right
Left
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17

Pediatric Teeth

A
B
C
D
E
F
G
H
I
J
Right
Left
T
S
R
Q
P
O
N
M
L
K

Remarks or Special Instructions

P: (406) 587-0767 / office@gvsurgicalarts.com
1994 Stadium Drive, Bozeman, MT 59715
F: (406) 587-0767 / www.gvsurgicalarts.com

To attach X-ray(s) to this referral form, please submit the form below. After the form is submitted you will then have the option to upload X-rays that will be attached to this referral form.

Need Help? Contact Our Team Today!

For urgent referrals or questions about the referral process, call us directly.

(406) 587-0767

We Can Answer All Your Burning Questions Now

Got questions? We've got answers!

To schedule an appointment with us, you can call our office during business hours, send a message or email at o, or y can stop by our office during visiting hours.
All insurance plans are different, but we can help you determine if your specific treatment at Gallatin Valley Surgical Arts is covered by your policy. Insurance policies are all different, and you should closely read about your coverage, or call your insurance company before your procedure. However, most dental insurance plans and some general health insurance plans at least partially cover wisdom tooth removal. Talk to your doctor and your health insurance company to learn more.
Given the nature of our work and the necessity for imaging, scans, and measurments to be made for the safest and most accurate restults, we only accept in person consults. We are happy to answer any questions you may have over the phone or email!
We recommend wearing loose-fitting clothing, short sleeves, and shoes with flat heels, especially for procedures involving IV sedation or general anesthesia. Our team will notify you of anything else you will require during your time with us.
Patients frequently travel to Gallatin Valley Surgical Arts from great distances to address their unique concerns. We have onsite licensure and credentialed services with overnight nursing care for nausea and pain management. Our medical team is used to accommodating these out-of-state patients and strives to minimize the inconveniences associated with travel. We are happy to help patients plan for travel, book accommodations, and coordinate care before, during, and after the surgery.
We offer several payment options, including credit cards, debit cards, and other forms of payment. We also partner with reputable financing companies to help make surgical procedures more accessible.

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