The Snyder Group
100 Centre Boulevard
Henry Schein PPT
Suite A
Marlton, NJ 08053
Phone - (856) 988-7588
Toll Free - (800) 988-5674
Fax - (856) 985-7428
Free Consultation
You have questions. We’re happy to help.

Register for a FREE 30-minute telephone consultation with a Snyder Group Transitions Consultant to get answers. Whether you are considering selling your practice, merging your practice, bringing on a partner or associate, retiring, relocating, or buying a practice, you’ll get our advice on what’s most important in your situation and what to do next.

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Name:   Dental School:
Degree/Title Year of Graduation:
  If Other Degree/Title: GP: Specialty:
E-mail Address:    
Where do you prefer all correspondence be sent?
(Please complete the appropriate address below)		 Home

Office
 
Home Address Office Address
Mailing Address: Mailing Address:
City: City:
State: State:
Zip Code: Zip Code:
Phone: Phone:
Cell Phone: Cell Phone:
Fax: Fax:
Average number of hours office open per week:
Estimated number of days you practiced this past year:
How long has your practice been established?
Practice is:
Sole Proprietorship Corporation
Partnership S Corp
Limited Liability Company C Corp
2010 Collections: ($)
Overhead Percentage: %
Do you own or rent your facility: Own

Rent
Square Footage of Your Facility:
Number of Operatories:
Number of Hygiene Days per Week:
Number of New Patients per Month:
Number of active patients (i.e., patients who have visited your office for at least one recall visit in the last 18 months):
Please estimate the approximate percentages of the sources of revenue in your practice:
a. Direct from the patient
%
b. PPO’s, DMO’s
%
c. Insurance\Indemnity
%
d. Other sources (please identify)
%
What percentage of clinical procedures are referred to area specialists?
Endo: %
Ortho: %
Implants: %
Perio Surgery: %
Pedo: %
Oral Surgery: %
Other:
What would you like to accomplish during our complimentary telephone conference call?

How did you hear about us?
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Snyder Group Client
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