MN Transitions Buyer Information Form

Prospective Buyer Information Form

Thank you for your interest in our practice opportunities. Please provide as much information about yourself as possible to help us find a great fit for your goals.

Please contact us if you have any difficulty completing:

Email - info@tntransitions.com | Voicemail - (952) 297-8308

We will be in touch as quickly as possible.

Contact Information

Name

First NameLast Name

Email

example@example.com - do not use @umn.edu addresses

Phone Number

Area CodePhone Number

How do you want to be contact?

Professional Profile

Dental School:

Graduation Year:

What is your practice area / specialty?

If General / Family, please check any additional treatments you provide:

Handedness:

States in which you are currently licensed to practice dentistry:

Please List All Current Licensures

Please describe current practice status (student, resident, owner, associate; name & location of practice):

Are you subject to any non-compete, non-solicitation, or confidentiality covenants?

If yes, please describe:

Are you subject to any Board of Dentistry investigations, consent degrees, orders, or other restrictions?

If yes, please describe:

Upload resume or CV (optional)

Upload a File

Goals for Practice Transition

Do you have a timeline for when you would like to purchase or join a practice?

What type(s) of practice are you looking for?

What state(s) would you like to practice in?

(list all you would consider, regardless of current licensure)

Do you have preferred areas or limitations within your selected states?

(cities, regions, point radius, etc. - provide as much detail as possible if you have strict limitations)

Desired number of treatment rooms:

only if applicable

Desired number of active patients:

only if applicable

Desired annual collections:

only if applicable

Do you want to purchase the practice building?

Other

Please describe any other aspects of your ideal practice opportunity:

Are you working with any other broker, attorney, CPA or other advisor to help with your practice transition?

If yes, please list who you are working with:

How Did You Hear About Us?

Where did you learn about True North's practice transition services?

Please provide details or name of referral source:

Thank you for taking the time to complete this questionnaire!