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150 Weiss Road
Ste. 102
Cottleville, MO 63376

ph. 636.447.2083

Supplemental Health Questionnaire

Request an appointment
If you have been exposed to a communicable disease, you may spread the disease to the orthodontist, orthodontic staff, or other patients/parents in the practice. Therefore, prior to each appointment, we will be asking the following questions to reduce the chances of a transmission:
Do you, your child, others accompanying you to today's appointment or anyone you have recently been in contact with have any of the following symptoms?
Fever (defined as above 99.6 degrees)?
Cough?
Shortness of breath and/or trouble breathing?
Persistent pain, pressurer, or tightness in the chest?
Have you, your child, others accompanying you to today's appointment or anyone you have recently been in contact with tested positive for or been diagnosed as having COVID-19 or any other communicable disease?
I understand that it the answer to any of these questions is yes, I may be asked to reschedule today's orthdontic appointment to a later date.
To the best of my knowledge, the questions on this form have been accurately answered. I understand that providing incorrect information can be dangerous to my (or patient's) health. It is my responsibility to inform the dental office of any changes in medical proceeding with dental treatment. I consent to use Electronic Records and Signatures.

 

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