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Purchaser Registration Form
"
*
" indicates required fields
Primary Contact
Contact Details (Name, Relationship to Purchaser, Phone, Email)
Purchaser Name
Salutation
*
Select
Dr.
Mr.
Ms.
Mrs.
Prof.
First Name
*
Last Name
*
Purchaser Current Location
City
*
Province
*
Select
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Postal Code
*
Purchaser Contact Information
Email
*
Phone (Primary)
*
Are you a practice owner?
Select
I Currently do NOT Own and am Looking for a Practice
I Currently Own a Practice and am Looking for a Second
I Currently Own Several Practices and am Looking to Expand
I Purchased a Practice and am No Longer Looking
I am no Longer Looking for a Practice
Hidden
Other
Updated by Web Form
Current Position
*
Select
Associate
Resident
Student
Owner
Partner
Other
Specialty Type
*
General
Endodontic
Oral Surgery
Orthodontic
Pediatric
Periodontal
Prosthodontic
Denture Clinic
Dental Lab
Hygiene Practice
Hidden
Province(s) in Which You Hold a License
AK
AL
AP
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
License Number
Please include all dental license numbers with Province abbreviation (where applicable)
Minimum Cash Flow Desired ($)
Minimum Number of Patients
Ideal Number of Operatories
Practice with Room to Expand
Select
Required
Preferred
No Preference
No
Ground Floor Retail Location Desired
Select
Required
Preferred
No Preference
No
Building Purchase with Practice
Select
Required
Preferred
No Preference
No
Type of Acquisition Desired
*
Practice
Facility and Equipment
Facility Only
Goodwill / Patient Charts Only
Partnership
Province(s) of Preference
*
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Select All
Please Select the Type of Content You Would Like to Receive
New Listings / Practices for Sale
Practice Values and Market Trends
Both - New Listings and Market Trends
By Checking "I Agree" Box You Agree to the Following:
*
I agree to receive commercial electronic messages (including, without limitation, promotional email, new practice listings, events and market information) from Tier Three Brokerage Ltd.
Please refer to our
Privacy Policy
or
Contact Us
for more details.
You can unsubscribe or withdraw your consent at any time.
I Agree
City or Area of Preference (1)
City or Area of Preference (2)
City or Area of Preference (3)
Is There Any Other Information You Would Like to Add Regarding Your Preferences (eg. Urban or Rural Locations)?
Where Did You Hear About Us?
*
Select
Convention / Meeting
Digital / Print (US)
Digital / Print (CAN)
Referral
Seminar
Webinar
Web Search
Social Media
Other
Created from Opportunity
Specific Source
*
Select
ADA
ADA / JADA
ADA (SmileCon)
Article (Henry Schein)
Article (not DPT Newsletter)
Banner Ad
Brochure/Leave Behind
Classified
Classified (e.g. Practice Listing)
Cotravel
Dental Business Institute
Dental Business Institute - Tuesday Webinars
Dental Market Watch
Digital / Banner Ad
DPT Landing Page (Business Solutions)
DSO Notification (Outbound)
DSO Submission
eBook
Email
Email / eBlast
Email / eBlast (TSC Generated)
External Upload
Facebook
Henry Schein Dental Catalog
Henry Schein Dental Flyer
Henry Schein Hosted
Henry Schein Transitioms Blog
HSDPT Auto Email (to Email)
HSDPT Auto Email (to Phone)
HSDPT Website (Listing Inquiry)
HSDPT Website (Listing Inquiry - DSO)
HSDPT Website (Live Chat)
HSDPT Website (to Call)
HSDPT Website (to Email)
HSD Website Banner
Instagram
JADA
Journal - BC Bridge
Journal - Bits & Bites
Journal - Capital Examiner
Journal - DAPEI
Journal - Journal de l'Ordre
Journal - Manitoba Bulletin
Journal - New Brunswick Bulletin
Journal - Nova Scotia Journal
Journal - Ontario Dentist
Journal - Oral Health
Journal - Saskatchewan News
Journal - The Updater
Letter (Print)
LinkedIn
Local / Provincial Journal
Local / State Journal
Local - Dental Society Meeting
Local Publication
Local - Study Club
Local - Study Club (Speaking)
Local - Study Club (Table)
MARS Report
National - Dental Economics
National - Dental Entrepreneur
National - Dental Product Shopper
National - Dentaltown
National - Dental Trader
National - Other
National - The Dental Network
National - The New Dentist
News about Henry Schein / HSDPT
Newsletter (eNewsletter)
Newsletter (Print)
Paid Ad / Pay per Click
Phone (Click to Web)
Phone Call
Post Cards
Prior Client / Friend
Professional Mixer
Provide Marketplace
Referral - Accountant
Referral - Attorney
Referral - Colleague
Referral - Dental Association
Referral - Dental School
Referral - FSC
Referral - HSD (Customer)
Referral - HSD (not FSC)
Referral - HSDPT
Referral - Lender
Referral - LPS
Referral - NDO
Referral - Other
Referral - Other Supplier
Referral - School Store
Regional - Other
Regional Publication
Search Engine / SEO
Search Engine Listing
Seminar - HSDPT Sponsored
Seminar - HSDPT Co-Sponsored
Seminar - Lender (not HSDPT Sponsored)
Seminar - Local Buyer
Seminar - Local Seller
Seminar - Local Society / Study Club
Seminar - Other (not HSDPT Sponsored)
Seminar - Regional Convention (HSDPT Sponsored)
Seminar - Regional Convention (not HSDPT Sponsored)
Seminar - State Convention (HSDPT Sponsored)
Seminar - State Convention (not HSDPT Sponsored)
Society - ADA
Society - ASDA
Society - State/Regional
Specialty
Specialty - Local
Specialty - National
Specialty - Regional
Specialty - State
State - CDA
State - CDA Fall
State - CDA Spring
State - Chicago MidWinter
State - FDA
State - Greater NY
State - Hinman
State - Other
State - Yankee Dental Meeting
Text Message
Thrive
ThriveLive
Twitter
Webinar - HSDPT Sponsored
Webinar - Lender (not HSDPT Sponsored)
Webinar - Other (not HSDPT Sponsored)
Website (not HSDPT)
Other
Other Direct Mail
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