Doctor's Choice Companies, Inc.
Florida Dental Practice Sales and Appraisals
Dental Associate Employer Placement
HOW DID YOU HEAR ABOUT US?
ENTER FULL NAME:
ENTER ADDRESS:
CITY:
STATE: ZIP CODE: -
HOME PHONE: () -
CELL PHONE: () -
OFFICE PHONE: () -
FAX PHONE: () -
EMAIL ADDRESS:
WHICH IS THE BEST WAY TO CONTACT YOU? (Cell, Office, Home, Email, etc. You can enter more than one)
DAYS NEEDED?
PAY SCHEDULE?
HMO% PPO% FFS%
ARE YOU LOOKING FOR A SPECIALIST OR GENERAL DENTIST? Specialist General
IF SPECIALIST PLEASE CHECK ALL THAT APPLY?
ENDO ORTHO PERIO PEDO PROSHTO
ORAL SURGEON OTHER:
EXPECTED HIRE DATE? (Immediate, ASAP, or Date)
DO YOU WANT FULL TIME OR PART TIME OR EITHER?
HOW CAN I SEND YOU THE ASSOCIATE PLACEMENT AGREEMENT?
FAX EMAIL MAIL
ASSOCIATESHIP ONLY BUY-IN EITHER (Associateship or Buy-In)
IS PLACEMENT CONFIDENTIAL? YES NO
PLEASE DESCRIBE OPPORTUNITY: (ASSOCIATESHIP AND/OR BUY-IN, EXPERIENCE NEEDED, NEW GRADS OK OR NOT, ETC):
Designed by SAHARA Solutions, Inc. Copyright Doctor's Choice Companies, Inc.