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?

Phone callTextEmail
Professional Profile
Dental School:
Graduation Year:
What is your practice area / specialty?

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

EndoSurgeryCERECSedationOrthoPerio
Handedness:

Right HandedLeft Handed
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?

YesNo
If yes, please describe:
Are you subject to any Board of Dentistry investigations, consent degrees, orders, or other restrictions?

YesNo
If yes, please describe:
Upload resume or CV (optional)

Upload a File

Cancelof
Goals for Practice Transition
Do you have a timeline for when you would like to purchase or join a practice?

As soon as possible1-2 years3-5 yearsUnsureCompletely depends on finding the right opportunity
What type(s) of practice are you looking for?

Solo Practice PurchasePartnership Buy-InAssociatshipAssociate to Buy-InSecond LocationRecords PurchaseOther
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?

Yes - I want a practice that offers the building for sale.No - I prefer to lease.I want the option to purchase or lease.I don't have a preference - either is acceptable.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?

YesNo
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?

Professional MeetingCampus VisitSocial MediaGoogle SearchReferred by a True North clientReferred by an industry professional (attorney, banker, realtor, vendor, dental consultant, etc.)Other
Please provide details or name of referral source:
Thank you for taking the time to complete this questionnaire!
Should be Empty: