ADS Precise Consultants

Buying a Dental Practice

looking_buy

Fill out and return the Buyer Forms

pdf_iconBuyer Forms

If you are interested in detailed information about practice purchase opportunities, we will need your promise of non-disclosure. This entails no cost or obligation other than your confidentiality. You can print this form above, complete it and send it to us or fax it to (303) 675-6161, or complete the online form:

Prospective Buyer/Associate Form

If you are interested in more information about practice purchase opportunities, we will need your promise of non-disclosure. This entails no cost or obligation other than your confidentiality. Please fill in this multi-page form below. If you have questions call us at (303) 759-8425.

Buying or selling a professional practice requires both parties to share substantial and confidential information with one another. Just as a Buyer needs information concerning a practice in order to evaluate it, a Seller needs some basic information about a prospective Buyer.




General Information


First Name of Buyer/Associate (*)

Please enter your first name.
Last Name Buyer/Associate (*)

Please enter your last name.
Email Address (*)

Please enter your email address.
Home Phone (*)

Invalid Input
Cell Phone

Invalid Input
Home Address (*)

Invalid Input
City (*)

Invalid Input
State

Invalid Input
Zip Code (*)

Invalid Input
Date of Birth (*)

Please enter your date of birth.
Spouse's First Name

Invalid Input
How did you hear about us? (*)









Invalid Input

Office Information


Office Address

Invalid Input
Office City

Invalid Input
Office State

Invalid Input
Office Zip Code

Invalid Input
Office Phone

Invalid Input
May we contact your office?

Invalid Input


Education



Professional Degree (*)

Invalid Input
Date Received (*)

Invalid Input
Dental School (*)

Invalid Input
Specialty/Residency

Invalid Input
Date Specialty/Residency Completed

Invalid Input

Dental Experience

(please list where & when you owned practices, were an associate, or had salaried positions and dates of each)

Name & Address

Invalid Input
Dates

Invalid Input
Name & Address

Invalid Input
Dates

Invalid Input


Licenses



State/Region

Invalid Input
License #

Invalid Input
Date

Invalid Input
State/Region

Invalid Input
License #

Invalid Input
Date

Invalid Input

Type of Practice/Position



GP/Specialty

Invalid Input
What are you interested in? Click all that apply.





Invalid Input

What are you interested in?



Please tell us your first priority (*)





Invalid Input
What is your second priority (*)





Invalid Input
What is your third priority (*)





Invalid Input
What is your fourth priority (*)





Invalid Input
States/Cities/Areas

Invalid Input
Please describe the characteristics of a practice that would interest you

Invalid Input
Practice Gross Revenue per year

Invalid Input
Practice Net Income per year

Invalid Input

Time Frame



By what date would you ideally want to purchase a practice or start as an associate?

Invalid Input
Do you need to sell a practice before you purchase a practice?



Invalid Input
If yes, please explain

Invalid Input


Financing the Purchase

If you will need a loan to purchase a practice, ADS Precise Consultants can usually assist you in securing financing, in an amount equal to 100% of the purchase price plus working capital, if needed. If you have been out of school for less than 2 years, the banks may require that you have a cosigner for the loan.


If you will need a loan to purchase a practice, ADS Precise Consultants can assist you in securing financing, in an amount equal to 100% of the purchase price plus working capital, if needed usually.

If you have been out of school for less than 2 years, the banks may require that you have a cosigner for the loan.

Would you like your contact information to be sent to lenders?



Invalid Input


Invalid Input
Do you have any cosigners for a loan?



Invalid Input
Relationship

Invalid Input
Have you ever declared bankruptcy?



Invalid Input
If yes, please explain / What year?

Invalid Input
Are there any unsatisfied judgments against you or any business that you have owned?



Invalid Input
If yes, please explain

Invalid Input


Military Service/Specialty/Residency



Are you presently in:




Invalid Input
Branch

Invalid Input
Years Served

Invalid Input
Rank

Invalid Input
Date of Separation/Discharge/Completion

Invalid Input
Are you using a buyer's agent?



Invalid Input
If yes, who?

Invalid Input

ADS Precise Consultants has no obligation to and will not pay a buyer's agent. Notify us if you have signed a buyer's agent agreement with any firm.



NON-DISCLOSURE OF CONF IDENTIAL INFORMATION AND PROSPECTIVE BUYER/ASSOCIATE AGREEMENT

Please read in its entirety and check the box at the bottom of this page.

Your Legal Name (*)

Please enter your legal name.

This agreement is between “Buyer/Associate”, and ADS Precise Consultants hereinafter referred to as “Broker/Consultant”. This agreement shall be enforced in accordance with the laws of the State of Colorado. Buyer/Associate wishes to evaluate confidential information regarding practice opportunities presented by Broker/Consultant.

• Buyer/Associate recognizes that any confidential information provide him/her by Broker/Consultant or its representative regarding professional practices could, if disclosed, cause damage to the individuals disclosing the information and to Broker/Consultant.

• Therefore, Buyer/Associate agrees that he/she will not divulge, communicate, or otherwise disclose any confidential material provided by Broker/Consultant, its representatives, or clients of Broker/Consultant, to anyone, including employees, customers, clients or clients, with the exception of his/her spouse, accountant, and legal counsel.

• Buyer/Associate further agrees that his/her spouse, accountant, and legal counsel will maintain the confidentiality of the material as well.

• Confidential information shall include, but is not limited to, the following:

1. A professional intent to buy, sell, or associate.

2. Any financial data provided Buyer/Associate by Broker/Consultant, its representatives, or clients, which may include such items as value of practice under consideration, income statement or balance sheets, Internal Revenue Service returns, and any other personal financial data.

3. Any personal information provided Buyer/Associate by Broker/Consultant, its representatives, or clients, which may include such items as data regarding lawsuits, pending lawsuits, malpractice suits, or other items personally pertaining to the principals in these transactions.

4. Patient or client lists made known to Buyer/Associate during negotiations.

5. Buyer/Associate shall not contact any owner or staff member of an owner referred to Buyer/Associate by Broker/Consultant without the express permission of the owner.

6. Buyer/Associate agrees to return any and all information provided to Buyer/Associate to Broker/Consultant immediately upon request.

7. In addition, Buyer/Associate acknowledges the following:

8. Broker/Consultant is seller's agent and does not have any fiduciary duties to Buyer/Associate.

9. Information provided by Broker/Consultant is provided by the Seller and is not audited by Broker/Consultant. Broker/Consultant makes no claims as to the reliability of any such data.

10. It is Buyer/Associate's sole responsibility to conduct his/her own due diligence and confirm the accuracy of all information provided to Buyer/Associate by the owner and Broker/Consultant prior to any purchase.

11. Buyer/Associate indemnifies and holds Broker/Consultant harmless for any claim, loss or damages including expense of defense arising from any transaction agreed to by Buyer/Associate, including but not limited to court costs, reasonable attorneys' fees and investigation expenses which, in any manner, arise out of or result from any practice purchase, employment, or affiliation.

12. Buyer/Associate is advised prior to any purchase, to review all financial and tax records of any practice, as well as personally perform a patient chart audit (subject to HIPAA regulations), determine patient count, review insurance plans, review HMO contracts, and any other information needed by Buyer/Associate.

13. Buyer/Associate acknowledges that Broker/Consultant is not an accounting firm and not a legal firm. Buyer/Associate has been advised to retain the services of competent and experienced legal counsel to review all agreements and other documents to be executed in connection with the sale/affiliation. Advice or opinion on the advisability of entering into a transaction shall be provided by Buyer/Associate's legal counsel. Buyer/Associate agrees any disputes regarding this document and any future transactions between the Buyer/Associate and the seller and the Broker/Consultant shall be resolved by JAMS Arbitration.

14. Buyer/Associate acknowledges that Broker/Consultant may receive a fee, if any, from a lender for loan packaging and administration.

15. Buyer/Associate has been advised to retain the services of an accountant to evaluate the data and the terms of the affiliation or sale including any tax liability resulting from such sale/affiliation.

16. All information provided to Broker/Consultant by Buyer/Associate is true and correct to the best of Buyer/Associate's knowledge, and may be presented to the owner of any practice under consideration for employment or acquisition by Buyer/Associate.

17. Upon completion of a transaction with Buyer/Associate, Broker/Consultant shall be permitted to print, publish and mail its usual and customary professional announcement of the transaction.



(*)

Please acknowledge that you have read and agree to the terms.

Comments or Questions?

Invalid Input


Invalid Input
Today's Date (*)

Invalid Input
Please enter the letters shown
Please enter the letters shown
   Refresh
Invalid Input

  

You are here Buy a Dental Practice