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150 Weiss Road
Ste. 102
Cottleville, MO 63376

ph. 636.447.2083

Confidential Patient Information

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Confidential Patient Information
Gender
Responsible Party Information
Dental Insurance Information
Emergency Information
Is patient taking any medication
Have you had any allergies or reactions to any of the following:
latex (gloves, balloon)

metals (jewelry)

acrylics

foods

ibuprofen

other antibiotics

Does or did the patient ever have:
birth defects or hereditary problems

endocrine or thyroid problems

diabetes

kidney problems

cancer, tumor, radiation treatment or chemotherapy

stomach ulcer, hyperacidity, acid reflux

aids or HIV positive

hepatitus, jaundice or other liver problems

tuberculosis, polio, mononucleosis, pneumonia

seizures, fainting spells, neurologic problems

arthritus or osteoporosis

mental health disturbance/depression

high or low blood pressure

blood disorders/bleeding problems/anemia

heart defects, heart murmur, rheumatic heart disease

angina, arteriosclerosis, stroke or heart attack

headaches or migranes

asthma, sinus problems, hayfever

tonsil/adenoid condition or removal

 

Bauer Orthodontics

patient rewards

Join Bauer Orthodontics Patient Rewards Program and discover how much fun it can be to collect points to use towards great prizes! It’s our way of saying thank you for trusting us with something as important as your smile. We offer many ways to earn points, from maintaining great oral hygiene and taking care of your braces to keeping up good grades in the classroom.

You can even earn points for participating in our great office contests! And when it comes to redeeming your rewards, we think we’ve got something great for everyone. Visit Bauer Orthodontics Reward Page to get started earning lots of points!

rewards hub

orthodontic excellence

about dr. bauer

Matthew J. Bauer, DMD, MS is an orthodontic specialist, providing the most advanced orthodontic treatment in St. Charles County.

Meet Dr. Bauer read more

the right age

Our treatment philosophy centers around insuring that your child's orthodontic care is timed appropriately for their individual needs

How old for braces? read more

your first vist

On your first visit, we will provide you with an introduction to our office and discuss your orthodontic concerns and goals.

Your first visit read more

office tour

We strive to provide a light,fun, warm and welcoming environment. Take a tour of our Cottleville office before you stop by!

Office tour read more