Practice Valuation Questionnaire
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Your Name
Phone Number
Format: (000) 000-0000.
Email
Practice Name
Practice Address
Year Practice Established
Date You Purchased
Real Estate Ownership
Please Select
Owned
Leased
Real Estate Size
Real Estate Value
Annual Real Estate Taxes
Monthly Rent Payment
Monthly CAM Fee
Portion of Common Area Maintenance, Property Tax, Insurance
Facility Size
Year Facility Built
Exam Rooms
Please Select
1
2
3
4
5
6
7
8
9
10
10+
Other Rooms
Facility/Practice Details
Management Software
Services Offered
Employees
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
20+
Doctors/Associates
Please Select
Solo DVM
2 DVM
3 DVM
4 DVM
5 DVM
6 DVM
7 DVM
8 DVM
9 DVM
10 DVM
10+ DVM
Working Hours (Each DVM)
Associate Retention
Seller Transition
2025 Gross Revenue
2024 Gross Revenue
2023 Gross Revenue
2022 Gross Revenue
Estimated Equipment Value
Equipment Leases/Contracts
Note: If the buyer does not want to assume ANY contracts, they will need to be paid off at closing as well as any debt that shows up on the UCC lien search.
Current Practice Debt
Amount Owed
Current Real Estate Debt
Amount Owed
Your Goals/Expectations
Background Information (Check All That Apply)
*
I have filed for bankruptcy within the last 7 years.
I have defaulted on an SBA loan.
I have faced disciplinary action by an authoritative body.
I have been convicted of or pled guilty to a felony that hasn't been sealed or expunged.
NONE of the background statements apply to me.
Submit
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