Seller’s Questionnaire

Please complete this form if you are interested in having Shea Practice Transitions assist you with the sale of your practice.

Your Name (required)

Please leave this field empty.

Your Email (required)

Can we correspond with you at this email address? (required)
YesNo

Where would you prefer to be contacted? (required)

What is your preferred method of contact?

Home Address

Can we correspond with you at this address and phone? (required)
YesNo

Office Address

Can we correspond with you at this address and phone? (required)
YesNo

Other Address, if applicable

Can we correspond with you at this address and phone? (required)
YesNo

Cell Phone

Your Age

Type of practice (i.e. general, ortho, endo) (required)

Briefly describe your need for a practice transition (required)

What is your timeframe to transition your practice? (required)

Is there anyone else that will be assisting you with your decision (e.g. consultant, accountant, attorney)? If so, please specify (required)

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