Buyer Profile Form - Madeline Gaiennie

Please fill out the form below. The information you submit on the form will be used to prequalify you for every listing you sign an NDA for, so please make sure to fill it out as thoroughly and accurately as possible. Information about your current locations of operation, funding, and healthcare acquisition experience are extremely important for our preapproval process and will determine whether we can share additional information on our listings. Please note that many of our listings require seller preapproval before the CIM can be shared, and we always require pre-approval for in-state buyers. If anything changes after you have completed this form, please feel free to reach out to us to provide the most current information. If you have any questions or need assistance, please contact Madeline Gaiennie at (310) 437-4443 or email


Contact Information


Company Information

No PO Boxes are allowed. Please provide a physical address for your company.
Please provide company revenue and/or other information indicating the company's size, such as number of locations, number of employees, and number of clients.
States your company currently operates in.

Buyer Profile

Please use numbers only.
(eg. Will you be self-funding? Are you backed by a private equity group? Will you be getting financing from a bank?)
Please list the names of the healthcare companies and the states they are operating in.

Email Notifications

Please select the categories for the types of listings you would like to receive email notifications about.
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