INSTRUCTIONS:  ROY BERRY CONSULTANTS, INC.
1.  Print out   6602 E. 91st. St.
2. Complete information Indianapolis , IN 46250
3.  Mail or fax   1-800-659-6117  Fax (317) 841-3162
royb@in.net   www.royberry.com

 

 

Roy Berry Consultant, Inc. do not provide appraisals or court room testimony engagements for marital dissolutions.

 

 

 

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Dear Dr. ________,

 

 

Ref: Terms and Conditions of Letter of Engagement

 

 

Thank you very much for your inquiry and the opportunity of being of service to you.

 

My fee for a dental practice "Report of Opinion of Fair Market Value", is $2,500.00 for a general practice □ and $3,500.00 for a speciality practice □. My fees are payable in advance and in the case of a Letter of Opinion of Fair Market Value, a retainer fee of $1,250.00 for a general practice and $1,750.00 for a specialty practice is required with the signed Letter of Engagement. The balance of $1,250.00 or $1,750.00 is due on delivery of the Letter of Opinion of Fair Market Value.

 When representing our clients, we also make other charges in addition to our fees. Typical of such charges are long distance telephone charges; messenger, courier and express delivery charges; facsimile charges; and printing and reproduction charges. A charge of $.50 a mile will be charged for practices beyond 75 miles from Indianapolis . We will bill you on a monthly basis for both fees and other charges and request that payment be made within ten (10) days of your receipt of our statement.

If the above is acceptable, please sign and date the Letter of Engagement, including your telephone numbers, and I will call you immediately on receipt for a date when I can personally enter the offices for a personal examination. Thank you very much.

 

Sincerely,

 

ROY BERRY CONSULTANTS, INC.

 

 

 

Roy A. Berry, President

RAB/jam

 

 

 

LETTER OF ENGAGEMENT

 

I __________________ agree with the above terms and conditions of this Letter of Engagement and authorize Roy Berry to prepare a Letter of Opinion of Fair Market Value for me. I understand that upon receipt of this Letter of Engagement and retainer, Roy Berry will contact me for a day when he can be allowed access to the office for a personal examination, at which time Mr. Berry will be taking pictures of the facility and asking the other various questions pertinent to the operation of the dental practice.

 

 

Signature ________________________ Date__________

Title

 

Printed Name _____________________________________

 

Office Address _____________________________________

 

_____________________________________

 

Telephone ____________________________

 

Note: Confidential address where correspondence may be sent to you.

_______________________________

_______________________________

 

 

Note:

 

When this letter is returned, please enclose as much of the following information as possible.

 

1. The Schedule C’s of your income tax returns, including any attached statements, for the dental practice or 1120’s if you are incorporated for the last 3 years, ____, ____ and ____.

 

2. An up to date operating statement reflecting gross receipts and expenses for the current year. (This operating statement should be as complete and up to date as possible).

 

3. A production by procedures report.

 

4. A production by provider report.

 

5. Filled out Staff & Practice Information questionnaire.

 

6. A check for the retainer fee of $1,250.00 for a general practice or $1,750.00 for a speciality practice..

 

 

 









  

STAFF & PRACTICE INFORMATION

 

 

Name_________________________ Home #__________________

 

Address_______________________ Office #__________________

 

 


Office Hours: S M T W T F S

 

______________________________________________________________________

 

Staff Job Tenure Salary Educa. Age Benefits

_______________________________________________________________________

 


_______________________________________________________________________

 

_______________________________________________________________________

 

_______________________________________________________________________

 

_______________________________________________________________________

 

_______________________________________________________________________

 

Rent or Own Rent Amt.____________ Value of Bldg._______________

 

Average # new patients per month_________________________________

 

Approx. average age of patients ___________________

 

Sq. footage of the office___________________# Of operatories__________

 

Location of office Free standing, Prof. office bldg., Strip center,

Other __________________________________

 

Reason for appraisal or sale _________________________________________

 

Are you doing any marketing now – how?___________________________

 

 

Major employers in the area______________________________________

 

_________________________________________________________________

 

 







Any specialties performed? Ortho. % of gross__________________

Other ___________________________________

 

___________________________________

 

Recall program __________________________________________________

 

Specialty pay % Insurance_________ % Cash___________________

 

% Medicaid__________ % Capitation_____________

 

Bookkeeping Pegboard______ Computer_______ Other__________