At Katie Hines Office Transitions, we emphasize the importance of matching dentists/dental buyers and sellers together to ensure a smooth and successful practice transition for both parties in Arizona.

If you are thinking of buying a practice, we would love to provide you further information to help you make your decision! During the course of our relationship with you, we will be providing you confidential information about practices that we have listed and sold. We ask that you please complete our Non-Disclosure and Confidentiality Agreement and answer just a few questions on our contact form so that we may serve you better!

Statement of Non-Disclosure and Confidentiality

WHEREAS, the Client recognize that any confidential information provided him/ her by Katie Hines Office Transitions or its representatives regarding professional practices could, if disclosed, cause damage to the individual(s) disclosing the information and to Katie Hines Office Transitions. The Client agrees that all information, which is disclosed by one party to the other in connection with business discussions, shall automatically be deemed confidential, proprietary and/or trade secrets unless otherwise confirmed in writing by Katie Hines Office Transitions. Therefore, client agrees that he/ she will not divulge, communicate, or otherwise disclose any confidential material provided by Katie Hines Office Transitions, its representatives, or clients of Katie Hines Office Transitions, to anyone, including employees, customers, clients, or prospective clients, with the exception of his/ her bonafide counsel. Client further agrees that his/ her bonafide counsel will maintain the confidentiality of the material as well. I, the Client, agree to and accept these terms. The online acceptance of these terms constitutes a legal and binding Non-Disclosure and Confidentiality Agreement.
Yes, I agree to the terms and condition above.*

*Title:
*First Name:
*Last Name:
*Degree:
*School:
*Year Graduated:
*Specialty/Profession:

*Address Type:
*Address:
*City:
		Zip: State:

*Phone:		- - *Type:
Phone:		- - Type:
Phone:		- - Type:
Fax:		- -
*Email Address:

*Average Annual Production:

*Number of Operatories:

*Reason for Selling:

*Is Office Leased or Owned?

*Square Footage:		SF

*How did you initially hear about us?

*Which is preferred method of contact?

Comments or Questions?

		* indicates required information