Non Disclosure Agreement For DSO

This Non-Disclosure and Acknowledgment Agreement is made between CTC Associates (“CTC”) and the undersigned. This Agreement may be signed electronically with our Group Buyers Application Form.

WHEREAS, CTC is a consulting firm engaged in the business of assisting health-care professionals in purchasing and selling practices and arranging for associateships, partnerships, and other practice transition-related programs; and

WHEREAS, the undersigned, in order to evaluate current and future practice acquisition, associate and partnership opportunities, must be informed of certain confidential information.

NOW, THEREFORE, the undersigned agrees not to disclose the name or circumstances of any parties introduced to the undersigned by CTC. The undersigned agrees that all information provided by CTC and/or any client of CTC, is confidential and agrees not to disclose to anyone or make copies of any of the information, ideas, procedures, tax returns, practice opportunities, programs, concepts, contracts and/or other data conveyed and entrusted to the undersigned (collectively called the “Information”) without prior written consent of CTC. In the event the undersigned wishes to discuss any such Information with an accountant, attorney, business consultant or other advisor chosen and retained by the undersigned, the undersigned shall notify such advisor(s) and agent(s) of the existence and terms of this Non-Disclosure Agreement to them and inform them they are bound by the same terms in their capacity as an advisor and agent for the undersigned. CTC may also require such advisor(s) and agent(s) to sign a copy of this same Non-Disclosure Agreement as well and submit it to CTC in lieu of obtaining prior written consent from CTC.

The undersigned agrees to comply with all restrictions, rules, and regulations of the Health Insurance Portability and Accountability Act of 1996 relating to the confidentiality of patient information.

Furthermore, in the event that undersigned either signs a letter of intent to purchase a practice listed by CTC or a consulting agreement whereby undersigned is represented by CTC, the undersigned authorizes CTC to investigate and/or discuss undersigned’s personal and/or credit history with prospective lenders in order to facilitate the funding and/or transition.

The undersigned acknowledges, understands, and agrees that CTC may be compensated by a third party for its services relating to providing funding for an acquisition of a practice by the undersigned.

The undersigned agrees that, upon request by CTC, any projections, calculations, word descriptions, and tangible material given to the undersigned relating to any practice opportunity will be immediately returned to CTC or destroyed.

The undersigned party has executed this Agreement on the day and year noted within the timestamp recorded by this website-system in completion of E-signature on the Group Buyers Application Form.