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150 Weiss Road
Ste. 102
Cottleville, MO 63376

ph. 636.447.2083

Form for Patients with Temporomandibular Disorder

Request an appointment
PATIENT HEALTH INFORMATION
SYMPTOMS
Please mark each symptom that applies
Head and Facial Pain
While sleeping, does your child...
Migraine type headache
Face side
Cluster headaches
Face side
Sinus headaches
Face side
Headaches in back of head
Face side
Hair and/or scalp painful to touch
Face side
Jaw Joint Problems
Joint clicking or popping
Face side
Grating noises
Face side
Jaw locks open
Face side
Limited jaw opening
Face side
Jaw does not open smoothly
Face side
Soreness of jaw joints
Face side
Soreness of face muscles
Face side
Teeth Problems
Teeth grinding
Face side
Teeth clenching
Face side
Soreness of one or more teeth
Face side
Looseness of one or more teeth
Face side
Ear or Balance Problems
Pain in ear
Ringing in ear
Clogged or stuffy ears
Diminished hearing
Dizziness or vertigo
Poor sense of balance
Throat Problems
Swallowing difficulty
Throat tightness
Throat soreness
Laryngitis
Voice fluctuations
Throat congestion
Frequent cough
Frequesnt throat clearing
Excessive salivation
Tongue pain
Pain in roof of mouth
Neck and/or Shoulder Pain
Neck/shoulder/back pain
Neck/shoulder/back reduced mobility
Frequent neck muscle fatigue
Arm or finger tingling, numbness, pain
Eye Problems
Pain around or behind eyes
Bloodshot eyes
Blurred vision
Pressure behind eyes
Light sensitivity
Watering of eyes
Drooping of eyelids

 

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