The Braff Group - A Health Care Mergers and Acquisition Company -- Buyer Questionnaire

Buyer Questionnaire After completing this questionnaire, please click on “Submit” button at bottom of page
Contact Information
Firm Name:
Address:
City:		State: Zip:
Contact:		Title:
Phone:		Fax:
Cell Phone:
Email:		Web Site:

Acquisition Criteria

Minimum Sales:

Maximum Sales:

Acquisition Criteria Comments:

Geographical Preference:
[CLICK ON STATES TO SELECT]

Geographical Preference Comments:

Industry Preference

Healthcare Services

Home Health & Hospice:

Medicare-Certified Pediatric Private Duty Medicaid / Waiver
Hospice

Pharmacy:

Infusion Therapy RX Distribution RX Institutional RX Retail
Specialty Pharmacy Compounding PBM Mail Order RX

Home Medical Equipment:

Durable Equipment / Oxygen Supplies Sleep Diagnostics
Mobility

Healthcare Staffing:

Allied Locums Per Diem Placement Travel
International

Behavioral Health &
Social Services:

Intellectual or Developmentally Disabled At Risk Youth / Child Welfare Acquired Brain Injury Adult Mental Health Welfare to Work
Addictions / Substance Abuse

Other Services:

Healthcare Information Technology

Other Areas of Acquisition Interest

Other:

Industry Preference Comments:

Financing Information

Interest as Minority Investor: Yes No

List Past Portfolio Companies in Health Care Service Sectors:

List Present Portfolio Companies in Health Care Service Sectors:

Financing Information Comments:

Additional Comments