Referral Forms

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

Patient referral form

Patient Information
Patient sex
Referral Information
Preferred Doctor
Procedures & Consultations

Select any procedures or consultations needed.

Teeth

Select the tooth or teeth involved. You can also describe them in the Remarks section below if you prefer.

Adult Teeth

Each tooth is a checkbox. Use Tab to move between teeth and Space or Enter to toggle. Tooth numbers follow the standard universal numbering system (right to left, upper arch first).

Pediatric Teeth

Each tooth is a checkbox. Use Tab to move between teeth and Space or Enter to toggle. Tooth numbers follow the standard universal numbering system (right to left, upper arch first).

Attachments (X-rays, Documents, Images)

Click Choose files to attach files from your device, or drag and drop. Accepted: images (JPG, PNG, GIF, BMP, TIFF), PDF, Word/Excel, text/CSV, DICOM, ZIP. Up to 100 MB per file.

Drag & drop files here

Or use the “Choose files” button above.

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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