Confidential Seller Interview Form

Buying and selling a practice requires both parties to share significant information with each other. If you have been considering the sale or transition of your dental practice, let us help you. Please take a moment to fill out our form below. All information you provide us will be kept strictly confidential. Once submitted we will contact you by your preferred method of contact to discuss your needs and concerns. We look forward to hearing from you.

 
 

Personal Information

First name: *

Last name: *

Email address: *

Date of Birth:

Spouse's Name:

Other Languages Spoken:

Right or Left Handed:

left right

 

Home

Home address:

City:

State:

Zip:

Evening Phone:

Day Phone:

Cell Phone:

 

Office

Office address:

City:

State:

Zip:

Office Phone:

Office email:

Fax:

 

Preferred method of contact: *

Why are you selling?

 

Is this confidential?

Yes No  

Is staff aware of plans?

Yes No  

I want to:

I am selling:

Estimated value of real estate:

Practice type:

Practice setting:

How long have you been in business at your current location?

Practice gross:

Number of doctors working:

My timeframe:

How did you hear about us?

Comments/Questions:

 
 

It may take a moment to submit your information. Please wait for a confirmation message.


UPCOMING EVENTS
2017 Events Preview

Seattle Midwinter Practice Transition Seminar
Bellevue Club
Friday, January 20, 2017

Portland Midwinter Practice Transition Seminar
MAC Club
Friday, Feburary 3, 2017

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Reasor Professional Dental Services | www.reasorprofessionaldental.com | 503-680-4366
PO Box 14276, Portland, OR 97293



 

 

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Reasor Professional Dental Services, PO Box 14276, Portland, OR, 97293 - Associated Words: Dental practice for sale Washington; Dental practice for sale Washington; 503-680-4366; www.reasorprofessionaldental.com; 6/23/2017