The Financial X-Ray

Are you the owner of one or more dental practices? YesNoN/A

If so, have you recently purchased your practice within the last 12 months? YesNoN/A

Are you in the process of buying a practice? YesNoN/A

Are you buying an existing practice or a startup? ExistingStartupN/A

When do you anticipate to close?

First Name

Last Name

Company

Email

Cell Phone

State ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

What is your annual collections for all locations? Less than $1,500,000$1,500,000 to $2,000,000$2,000,000 to $2,500,000More than $2,500,000

Do you know your practice's EBITDA? YesNoWhat is EBITDA?

How many chair(s) do you have?

How many associates do you have?

What is your average number of new patients per month?

Do you own your office real estate? YesNoN/A

What is your ideal relationship with a CPA or accounting firm?

Where did you hear about us?

If you were referred - by who?

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