Are you the owner of one or more dental practices? Yes No N/A
If so, have you recently purchased your practice within the last 12 months? Yes No N/A
Are you in the process of buying a practice? Yes No N/A
Are you buying an existing practice or a startup? Existing Startup N/A
When do you anticipate to close?
First Name
Last Name
Company
Email
Cell Phone
State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
What is your annual collections for all locations? Less than $1,500,000 $1,500,000 to $2,000,000 $2,000,000 to $2,500,000 More than $2,500,000
Do you know your practice's EBITDA? Yes No What 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? Yes No N/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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