Syracuse Dentist, Joan C. Laura, D.D.S., Family & Cosmetic Dentistry

Are you a Candidate?
Please take a moment to fill out the form below. We will be happy to answer any questions or concerns you may have.

Fields marked with * are required.
First Name*:
Last Name:
Phone Number:
I would like to be addressed as:
Email Address*:
Mailing Address:
What are you trying to accomplish? other:
What type of procedure are you considering?
(1.)Have you had this procedure done previously, or any other procedures similar to it? if no, please go to question #2
Yes No
(a.) What was the purpose of the procedure?
(b.) If this procedure was done for health reasons, what were those reasons specifically? (please be as detailed as possible.)

(c.) When was your procedure performed? (mm-yy)
(2.) Are you expecting insurance to pay for any part of your treatment? (They usually will pay only if you need treatment for dental health reasons.)
Yes No
If you are, what is the name of your insurance company?
-- EXPECTATIONS --
List in priority the things about your smile that bother you and what you would like corrected.

If you have the treatment done, what are your realistic desires, i.e. what will/would it take for you to be satisfied with the outcome? (Think about this and be honest.)

Do you have any questions or concerns?

Anti Spam Question: How do you spell "rotator" backwards?*

Hours:
Monday-Thursday
8:30 a.m.-5:00 p.m.

Dr. Laura's formal education and hands-on training are second to none. Some of her qualifications include:

A dental degree from the reputable State University of New York at Buffalo

More than 600 hours of continuing education

Formal training in art, which honed her artistic vision

Membership in the American Academy of Cosmetic Dentistry and the American Dental Association

Joan C. Laura, D.D.S., P.C.
Eastwood Dental Center
2326 James Street
Syracuse, NY 13206
Phone: (315) 438-3333
Fax: (315) 437-7276