Buck: (503) 680-4366
Megan: (503) 830-5765
Rod: (206) 979-2660
3519 NE 15th Ave,
Portland, OR 97212-2356

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 address:




Evening Phone:

Day Phone:

Cell Phone:



Office address:




Office Phone:

Office email:



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?



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

2018 Events Preview

Portland Midwinter Practice Transition Seminar
MAC Club
Friday, January 26, 2018

Seattle Midwinter Practice Transition Seminar
Bellevue Club
Friday, February 2, 2018

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Reasor Professional Dental Services merging with Omni Practice Group | www.reasorprofessionaldental.net | 503-680-4366
3519 NE 15th Ave., #201, Portland, OR 97212



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Reasor Professional Dental Services merging with Omni Practice Group, 3519 NE 15th Ave, Portland, OR, 97212-2356 - Related Phrases: Dental practice for sale Washington; Dental practice for sale Washington; 503-680-4366; www.reasorprofessionaldental.net; 6/24/2018