* Current Address
Dental School graduated from:
How many years has it been since you graduated from a Dental School?
6 months or less
If you have not graduated, what year will you complete schooling?
Current States with active Dental License:
Type of opportunity seeking
What is your ideal work schedule?
1 day a week
2 days a week
3 days a week
4 days a week
5 days a week
Please elaborate on your ideal work schedule.
Type of practice opportunity seeking
Region most desired
Type of area desired
Medium Sized Community
Approximate date available to start
* Approximate date available to start
Do you have any ongoing malpractice cases or complaints against their license
Have you ever owned a dental practice
Are you interested in practice ownership at some point in your career?
Are you currently bound by a non-compete?
How did you hear about us?
By submitting this electronic form, The Undersigned party agrees not to disclose the name or circumstances of any parties introduced by Commonwealth Transitions LLC . The undersigned party also agrees that all information provided by Commonwealth Transitions LLC regarding Dental practice opportunities is confidential and agree not to disclose to anyone or make copies of any of the information, ideas, procedures, programs, concepts, contract and/or other data conveyed and entrusted without the prior written consent of Commonwealth Transitions LLC. In addition, Commonwealth Transitions LLC and the Seller requests that any projections, calculations, descriptions, and tangible material given will be immediately returned to Commonwealth Transitions LLC, and or destroyed.
By clicking the box below I agree to the above terms, and this acknowledgement is equivalent to a signature.
I agree to these terms.
Thank you for your application. We will be in touch soon!