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* 1. Practice Name

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* 2. Mailing Address

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* 3. E-mail Address

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* 4. Phone Number

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* 6. Number of years in practice

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* 7. Number of Dentists

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* 8. Do you have any associate dentists working at your practice?

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* 9. If yes, how is their compensation structured (ex. Guaranteed salary of $XXX, Set percentage of production or collections, are they charged with their labs, etc.) Please describe.

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* 10. Annual collections in..

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* 11. Total number of patients in...

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* 12. What is the total square footage of practice?

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* 13. Do you lease or own your building?

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* 14. What is your monthly rent expense?

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* 15. Does rent include utilities, real estate taxes, & insurance?

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