Valuation Request Form
Title
Dr
Mr
Mrs
Ms
Miss
Other
Surname
First Name
Private Phone Number
Email
Practice Address
Select an option
Freehold
Leasehold
Long Leasehold
Freehold Value
Estimated Value in £s
NHS Contract Value
Private Turnover
Estimated Private Gross Income in £s
Total Practice Turnover
Number of Surgeries
1
2
3
4
5
6
7
8
9
10+
Computer System
Software of Excellence
R4
System for Dentists
Other
None
Additional Information
Reason for sale, number of years in the practice, brief description of the premises and location.