Customize Your Preferences

Name*
First Last
Phone*
Email*
I am:*
- A New Patient
- A Existing Patient
During my dental visit, I would usually prefer to:*
- Watch TV
- Watch A Movie
- Listen to Music
- Have Quiet
If I were to watch TV, my favorite channels are:
If I were to watch a movie I would prefer to watch:*
- Comedy
- Adventure
- Action
- Drama
- Documentary
- Thriller
My favorite type of music is:*
- Rock
- Classic Rock
- Pop
- Alternative
- Jazz
- Classical
- Opera
- Broadway Hits
- Spa / Relaxing
- Rhythm and Blues
- Country
My Favorite groups / artists are:
I would prefer to have wireless headphones during treatment*
- Yes
- No
I would prefer to have Nitrous (laughing gas) during treatment*
- Yes
- No
The types of appointments I prefer are:*
- Morning
- Lunch Time
- Afternoon
- Anytime
I prefer to be seen:*
- During the Week
- On the Weekends
- Doesn't Matter
Additional Special Requests
*
- I accept the Terms of Use *
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Marc Lazare, DDS

115 East 61st St., Suite 14A
New York, NY 10065
Phone: (212) 861-2599
E-mail: Office@drmarclazare.com

MARC LAZARE, D.D.S., M.A.G.D.

Dr. Lazare has been a member of the clinical faculty at the NYU College of Dentistry and has been on the teaching staff at North Shore University Hospital since 1998.
Dr. Lazare started the Teeth Whitening Division at North Shore University Hospital utilizing the latest technologies.

Popular Procedures

Teeth Whitening
Procelain Veneers
Dental Implant Restoration
Biomemetic Dentistry

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© Copyright 2017. Marc Lazare, D.D.S., M.A.G.D. | Aesthetic Excellence | 115 East 61st St., Suite 14A New York, NY 10065 | Phone: (212) 861-2599
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