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    Fee Report RequestFee Report Request

    Thank you for your interest. Once you have submitted this form, a member of our team will contact you with your analysis. If you have questions in the interim, please feel free to contact us at info@adsflorida.com or (800) 262-4119.

    Note: Please complete the entire form. The information will only be used by Henry Schein Professional Practice Transitions and is not to be transferred to any other party.



      Your Name:
       


      Year you Started Practicing:
      Sq. Footage of your Office:
      Number of Operatories:
      City of Your Practice:
      Zip Code of Your Practice:
      Preferred Phone Number:
      Preferred Email Address:
      Your Dental Specialty:
       
      In the next five years, I plan to:






       
      Please contact me about:






         
       
       
      How you found ADSFlorida.com:
         
      ADS Florida eNewsletter*:
         
      Questions or Comments:


    * we do and will not share our e-Newsletter list with any third party.

     
    		 
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