Commonwealth Transitions

Application

Step 1 of 3 - Getting Started

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Listing ID

Name*
First Last
Home Street Address*
City*
State*
Zip*
What year was the practice founded?*
How was the practice started? Purchased from another doctor? Startup?*
Do you use any type of sedation (nitrous, IV)?*
Do you accept Medicaid?*
If so, roughly what percentage of collections is Medicaid?
Is your office mercury free?*
Are you incorporated? If yes, please email us a copy of your Articles of Incorporation.

Employees*

Name	Postition	Year Hired	Expected to stay?	Annual Value of Benefits	Hourly Rate	% of Collections	Is this employee family?

How many parking spaces are there?*
Do you have a lease? If yes, please email us a copy of the lease.*
What is the office square footage?*
How many operatories do you have?*
Are all operatories in use? How many do dentists use? How many do hygienists use?*
Are you right or left handed?*
What practice management software and recall system do you use? (Ex. Eaglesoft, Softdent, etc.)*

Dental Chair(s)*

Make	Model	Approximate Age (Years)	Quantity

Dental Unit(s)*

Make	Model	Approximate Age (Years)	Quantity

Dental Light(s)*

Make	Model	Approximate Age (Years)	Quantity

Dental X-Ray Sensor(s)*

Make	Model	Approximate Age (Years)	Quantity

CAD/CAM(s)*

Make	Model	Approximate Age (Years)	Quantity

Panoramic X-Ray(s)*

Make	Model	Approximate Age (Years)	Quantity

Scanner(s)*

Make	Model	Approximate Age (Years)	Quantity

New Technology Purchases*

Make	Model	Approximate Age (Years)	Quantity

Work With Us

Please contact us to schedule an appointment to meet and discuss your Dental Transition needs.

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First Last
Email address*
How can we help you?
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