Request a Confidential Practice Valuation This helps us understand your practice and goals so we can provide a realistic valuation range and transition options Contact Information Practice Basics Performance snapshot Payer and Services Facility and Lease Technology and Equipment Transition Goals Consent and Disclaimer Blank Form (#5)Δ Full NamePhone NumberEmailBest time to reach youPreferred contact methodPractice City and CountyPractice Type GP Ortho Pedo Endo OS PerioOwnership Structure Solo PartnershipAre you the owner? Yes NoLast 12 months collection- Select -$500–$750k$750k–$1M$1–$1.5M$1.5M+Last 12 months adjusted net / take-home- Select -$500–$750k$750k–$1M$1–$1.5M$1.5M+Active PatientsOperatories (Plumbed)Staff count (front/back)Payer Mix FFS%Payer Mix PPO%Medicaid/Denti-Cal %Top procedures GP Ortho Pedo Endo OS Perio Multi SpecialtyAre fees at/above/below local averages?Facility Lease OwnCurrent rent + lease term remaining + optionsSq ftParking Yes NoCondition Updated Average DatedDigital Sensors Yes NoCBCT Yes NoIntraoral Scanner Yes NoCharting SoftwareMajor equipment age/conditionTimeline- Select -0–6 months6–12 months1–2 years2+ yearsUnsureIdeal Outcome- Select -Sell 100%Partial Buy-InBring associate then sellDSOs consideredConfidentiality Level- Select -High (no staff know)ModerateOpen I confirm I’m authorized to share this information and understand this is an estimate, not a formal appraisal. MDBL will keep this confidential and won’t share details without permission.Submit Form