Home
Valuation
Transition
Ready to Sell
About
Newsletter
Contact
Home
Valuation
Transition
Ready to Sell
About
Newsletter
Contact
TRANSITION YOUR PRACTICE TO A DSO
Dental Practice Transition Questionnaire
Let’s Get Started!
Transition Form
Contact Information
Role
*
Practice Owner
Office Manager
Other
Role
First Name
*
Last Name
*
Email
*
Phone
*
Fax
Gender
*
Male
Female
Year of Graduation
*
Practice Name
*
Practice Website/URL
What is your NPI#?
*
Transition Questions
Specialties
*
General Dentist
Oral Surgeon
Prosthodontist
Orthodontist
Pedodontist
Endodontist
Do you plan on transitioning in the next 1 to 3 years?
*
Yes
No
Unsure
Would you like to initiate discussions with a Potential Buyer about a possible Transition of your Practice?
*
Yes
No
Do you have a preference to whom you would like to sell your practice?
*
DSO/Dental Group Practice
Solo-Practicing Dentist
Management Firm
Private Equity/Investment Banker
With the Help of a Qualified Dental Broker
Keep in mind, the more boxes you check, the greater the success of a sale and we may not be in a position to help you if you limit your options.
Do you own or rent?
*
Own
Rent
Other
Other
Number of Office Locations
*
Number of Operatories
*
Number of Fulltime Dentists
*
Number of Part-time Dentists
*
Annual Revenue
*
What percentage of your practice revenue is from Denal Hygiene?
50
Percent of Revenue with Medicaid as Payer
50
Is your staff aware of your transition plans?
*
Yes
No
Additional Comments
Agree
*
I have read and agree to the Terms & Conditions and Privacy Policy.
Submit