Practice Valuation Fee Quote Questionnaire (See the DDS ValuePoint™ page for more information)   First: Please provide your contact information. We do not share your private information to other companies. See our Privacy Statement for details of our policy. Doctor's Name Practice Name (if different than above):  Practice Address: Practice City/State/Zip: Practice Phone: Practice Fax: Home Phone: E-Mail Address: Web Site Address: Home Address (optional): Preferred Address? Home City/State/Zip: Type of Practitioner (Check All That Apply) General Dentist Periodontist Endodontist Pediatric Dentist Oral Surgeon Prosthodontist Orthodontist M.D. Educator Other    Next: Please complete each item below for our professional valuation affiliates. We will prepare a valuation quote for you. Berning & Affiliates is acting solely in an administrative capacity. Please describe the purpose for which you want the practice valued (i.e. selling the practice, forming a partnership, buy-sell agreement between co-owners, gifting, divorce, etc.) Are you the:  Practice Owner   Prospective Buyer Other Please briefly describe the practice: Number of office locations    Are there associates in the practice? NO   YES  If yes, under what arrangement?   Employee   Independent Contractor  Non-Owner solo group How many practitioners are in the practice: Full Time (3+ days)       Part time (1-2 days) Do you wish an on-site visit for the valuation?  YES   NO Are you willing to provide all necessary related information to perform the valuation? YES   NO      AFTER COMPLETING ALL INFORMATION, PRESS "SUBMIT" Top