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Let’s get started with your confidential dental practice assessment today.
Title
(Required)
Dr.
Ms.
Mrs.
Mr.
Name
(Required)
First
Last
Mobile Phone Number
(Required)
Email Address
(Required)
City
(Required)
Province
(Required)
Select province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
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Date
MM slash DD slash YYYY
Preferred Time To Call
Hours
:
Minutes
AM
PM
AM/PM
Time Zone
Choose
Pacific
Mountain
Central
Eastern
Atlantic
Newfoundland
Please choose one of the following that best describes you.
I’m a clinic owner of an established clinic or group of clinics and interested in partnership opportunities.
I’m interested in learning more about De Novo (New) Clinic builds.
I’m interested in both. Let’s connect.
Would you like to expedite our communications with you by answering some more detailed questions about your practice?
No
Yes
All information submitted on the 123Dentist platform will be held in strict confidence. This means that the information you share with us will not be released to anyone without your written permission, except as set forth in the 123Dentist
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Practice Details
Practice Name
(Required)
Website / URL
Number of Dentists
1
2
3
4
5+
Number of Ops
1
2
3
4
5
6
7
8
9
10+
Number of active patients
0 - 1,000
1,000 - 2,000
2,000 - 3,000
3,000 - 4,000
4,000 - 5,000
5,000 - 6,000
6,000 +
Practice Principal Details
University
Graduation Year
Additional Practice Details
Type of dentistry
General Dentistry
Fixed Orthodontics
Endodontics
Periodontics
Prosthodontics
Oral Surgery
Crown / Bridges
Invisalign / Clear aligners
Implants
Paediatric Dentistry
Dentures
IV Sedation
Technology
Digital
2D/3D Pan
Intraoral Camera
CAD/CAM (CEREC)
Chartless
CBCT
iTero
Laser
Software Used
Abeldent
ClearDent
DentalVision
Dentitek
Dentrix
Dolphin
Eaglesoft
Gold Dental
LiveDDM
LogicTech
Maxident
Opes
Paradigm
Power Practice
Tracker
Vision
Other
If other, please provide
Partnership Planning
Why are you looking to have this conversation?
Succession / Transition
Relieve Administration Burden
Support in Growth of Practice
What is most important in a partnership?
Work-Life Balance
Retained Ownership
Operations Support
Recruitment
Marketing
Supported Autonomy
Diversify Asset
Training & Development
Human Resources
Purchasing Savings
Anything we should know before we have a conversation?
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