Buyer Inquiry - Practice Exchange

If you couldn't find a practice in the area you want use the form below to contact us, and tell us about your requirements so we can help you find exactly what you are looking for.

First Name*
Last Name*
Email*
Title*
Personal Cell Phone*
For privacy matters we request you provide a mobile phone number, not an office or work number.
Company Name*

Enter N/A if not applicable.
Desired State and County of Practice
Desired City of Practice
Consent*
I agree to the confidentiality and non-disclosure statement.
CONFIDENTIALITY AND NON-DISCLOSURE STATEMENT
Buyer acknowledges that Practice Exchange (“PEX”) and, or Owner shall furnish Buyer with certain confidential and proprietary information pertaining to the Owner’s practice, including, but not limited to tax returns, profit and loss statements, fee schedules, employee records, equipment, patient lists, appraisals, leases, etc. In consideration for PEX and, or Owner providing the aforementioned information, Buyer hereby agrees to the following:

That all the information and documentation provided to or disclosed to Buyer are private in nature and shall remain confidential. Buyer aggress not to disclose to any person, firm, or corporation without Owner’s express written consent any information or documentation that Buyer shall acquire regarding Owner’s practice, except to Buyer’s attorney or accountant. Buyer further agrees not to disclose to anyone the fact that the practice is on the market or for sale. Buyer agrees that the disclosure of any information or documentation with respect to the practice of Owner would cause Owner irreparable harm and damage. Buyer further agrees that Buyer will hold harmless and indemnify PEX and Owner in the event of disclosure of any information or documentation respecting Owner’s practice, except as herein noted.
That the information and documentation forwarded to Buyer pertaining to the Owner’s practice is to be used solely to assist Buyer in deciding whether to purchase said practice and will not be used in any other manner for personal or professional benefit.
That in the event Buyer decides not to purchase the abovementioned practice, Buyer will immediately notify PEX, or Owner of this decision and will return all documentation without retaining copies or extracts thereof.
That Buyer will not directly contact the practice employees, or any agents of the practice without Owner’s express written consent.
By accepting this agreement, Buyer is stating that he/she understands all the terms and conditions, the same as if he/she was signing the agreement.
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