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