Please fill out this form. This gives us the necessary information about your practice that allows us to analyze the practice.
Please fill out this form and submit your information all at once.
Thank you for allowing us to work with you.
By providing the requested information and clicking Submit above, I hereby consent and agree as follows:
1. I hereby authorize PRACTICE MANAGEMENT CENTER, LLC ("PMC") to provide my information to Vision One Credit Union for financial analysis relative to my ability to acquire a partial interest in or all of an optometry practice, and I understand that I may be contacted directly by Vision One Credit Union relative thereto.
2. I understand that my information will only be used for this purpose or to comply with any legal or regulatory requirements, and that PMC will keep my information confidential and not disclose or make available any part of my information to any other third party without my prior written consent nor directly or indirectly use, or permit others to use, my information for any other purpose and to take all reasonable and necessary measures to secure and maintain the confidentiality of my information.
3. I hereby authorize and agree that PMC may provide me by email or any other means educational information and materials and information about presentations and seminars relative to optometric practice management topics, and I agree to maintain my current contact information with PMC for such purposes.