Integrated Family Care
Confidential Ownership Interest Inquiry
Thank you for your interest in the ownership opportunity at Integrated Family Care. Please complete the information below. All submissions will remain confidential.
Contact Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Employer or Practice
Specialty
Board Certifications
Years in Practice
Professional Background
Are you currently:
Please Select
Employed Physician
Practice Owner
Partner
Resident/Fellow
Other
Do you currently practice:
Please Select
Direct Primary Care
Concierge Medicine
Traditional Primary Care
Lifestyle Medicine
Other
Interest
What interests you most about this opportunity?
Please Select
Ownership
Direct Primary Care
Lifestyle Medicine
Cincinnati Location
Entrepreneurship
Investment Opportunity
When are you hoping to transition?
Please Select
Immediately
3-6 months
6-12 months
12-24 months
Ownership Preference
Please Select
Immediate Buy-In
Staged Buy-In
Employment Leading to Partnership
Unsure
Do you anticipate financing the purchase?
Please Select
Yes
No
Unsure
Please tell us why this opportunity interests you.
By submitting this form, I understand additional information will be provided only after execution of a Confidentiality Agreement.
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