Dental practice from scratch/ start-up question

Discussion in 'Dental' started by Bigticket21, May 14, 2007.

  1. Bigticket21

    Bigticket21 Junior Member

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    I am currently a 4th year and was looking at opening a practice from scratch. Basically, I am looking for some form of a template for the bank to have prior to asking for a loan. Does anyone have a template business plan for a dental practice? The one's I found online aren't exactly free. Just wondering.
     
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  3. Jamster

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    My friend, i would advise that you get at least 2-3 years experience after DDS school before you go that route. It's not just as easy as buying a practice and earning $$$$. You need to experience the runnings of a private practice before you buy one, they don't teach you that in dental school!

    Best of luck.
     
  4. krstfrb

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    Hi Bigticket,
    I think you should be looking at dentaltown. There is a forum on starting your own practice, and if you ask this question there, I am sure they will ask you all the right questions, and get you pointed in the right direction. These are mostly practicing dentists, and I am sure, many have gone through what you are attempting and will have a lot of good advice.
    Good luck!
     
  5. drben

    drben Member
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    Back in the day, I used software specific for developing a business plan. It helped and put things in a nice, easy to read format. Sorry, I don't recall the name but I'm sure if you Google "Business Plan Software" you'll find what you need.

    Don't listen to the pessimists...if you think things through well, you will be succesful in a start up. Do your homework, and be patient and things will work out.

    Ben
     
  6. jaxdds

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    go for it, depending on where you are in the country it may be a great idea, a lot of existing practices are outdated and you might have to but all new equipment in a few years anyway, so why pay for a practice then new equip? talk to a vendor, such as henry schein or patterson dental and they have the complete services to offer 'from scratch' practices. you may pay a little more but the service is outstanding and worth it. plus, plan for growth, the biggest mistake you could make is leasing space that is too small then you outgrow it. think how hard it is to move dental dental equip :) hope this is not too late
     
  7. Buck1

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    You don't need a formal template to have a business plan for a bank. They are not used to seeing that from a dentist, because we are good investments. Just be honest with yourself. Have a plan for yourself, like what is your vision, how are you going to get new patients, when are you going to hire your first team member, how many treatment rooms, what will your expenses be, how much do you anticipate each patient will spend........you just need to sit down and think it out, then put it on paper.
     
  8. DrJeff

    DrJeff Senior Member
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    Also consider buying a practice from a retiring dentist in the area you'd like to practice in, that way you'll atleast have some patients to start with and a staff to help you.

    Or potentially a buy in/buy out arrangement where essentially you buy the practice from the existing dentist, who then works for you as an associate for a period of time before he/she retires. It can act as a nice transition for established patients to meet you and give you someone to turn to for some advice about how the business side of things works
     
  9. I'mFillingFine

    I'mFillingFine Pulptastic
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    I was thinking about this issue. If you save a few hundred thousand dollars by building from scratch and NOT purchasing all the records from an existing practice, will you end up losing all that money if it takes a few years to build up the pt base?
     
  10. OceanBlue

    OceanBlue HA! I knew it.
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    yup! dentaltown can help you a bit with your question.
    You have two options: buying an existing practice or build one. There are pros and cons for each option. One good thing about buying an existing practice is that you can start out right away because you already have the staffs and the patients. However, buying an existing practice comes with existing problems that you have to live with. I'm still reading, learning, and asking, but for now the option of building one from the ground seems to be more attractive. When you build one, you have the option of equipping just 1-2 ops and hire just 1-2 assitants starting out, this way you're not so deep in debt. After you build your patient base and have a bit more money, you can equip the other ops and hire more assitants. It'll probably take up to to 1yr to build one from the start, so within that one year you can work as an associate while building it. Please comment on my thinking.
     
  11. Daurang

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    Yes, your logic is correct. It is very possible to build a basic 2 ops practice from scratch for under $100,000 if that is what you wish. Any dental supply company will gladly come by and design and lend you money.
     
  12. OceanBlue

    OceanBlue HA! I knew it.
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    Thanks for your comment. I'm thinking of a practice with 5 ops, but with only 2 fully-equipped ops and 3 plumbed ops. Later on, expand to 3-5 fully-equipped ops when you have more patients. I still don't know whether you should lease the space for your practice or get a floor plan and build from the ground up. Daurang....how did you start your practice? If you don't mind, can you tell me the %race distribution in your practice?
     
  13. Rezdawg

    Rezdawg 1K Member
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    Ocean, I think building from ground up is the way to go. You'll get off to a slower start, but during that time, you can work as an associate to make up for the relative inactivity of your startup. But, on the plus side, you've designed your practice to fit your needs and desires.

    As far as space, Ive also been told that you want about 400 sq ft per op, optimally speaking...but you could get by with 300-350 if you're short on space. So, if you are looking at 5 ops, then you need at least 1500 sq ft. to make it work.

    Dentaltown is a great place to read about such things...and little fact like needing 2.2 seats per operatory. Things that you just cant find anywhere else. Im far removed from setting up a practice, but its still interesting to look through those threads and get some ideas...cant start too early.

    Any thoughts on owning a Cerec? Seems like fun.
     
  14. OceanBlue

    OceanBlue HA! I knew it.
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    Rezdawg,
    From what I know now (i do not know a lot), my preference to build a fresh one vs buying an existing is about 51% to 49%. Immediate "cashflow" is such an important factor, and I do not think we should overlook it. Sure there are existing problems, but if you have a vision you can change and shift the practice to the way you want; however, it requires strong leadership. When you buy a practice, you can start working from day 1. You do not have to worry about hiring, some of the paperwork, and loads of other headaches. I am definitely opened to both options. What are your thoughts?
     
  15. Rezdawg

    Rezdawg 1K Member
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    I agree, immediate cashflow is very important...you dont want to be going through lengthy periods of time without any income. However, you can start off this way...after your office has been built, work as an associate 4 days a week and work at your own practice 1 day a week. Have 1 person taking calls for you 5 days a week at your office. Therefore, you'll be working ~32 hours a week as an associate in order to bring in enough cashflow to be comfortable and at the same time, you are slowly incorporating your own practice into your schedule. As your patient base grows, you begin working less as an associate and more time to your practice. Eventually, you work your way out of associateship and dedicate 100% of your time to your practice. This way, you have slowly built your practice up and been able to do so without a significant loss in income. Im not sure how logical my thoughts are or if its even feasible, but that's what Ive been thinking. Dr. Jeff may come in and shatter my thoughts :D
     
  16. johntara04

    johntara04 Member
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    If you can open your practice with minimal expenses, you could associate 2 days a week and be in your practice 3-4 days (including Sat. sucks, but your just starting off, can't have the whole cake the first day). If you can do $2000 a day associating that is $5600 a month take home. Now, if you can do $1000 a day in your office (on average, obviously, some days you will do more starting out, some days you will do nothing) and with 70% overhead (which is way, way high, if you can keep your startup costs under $100,000 as someone suggested your overhead would probably be around 50%), you will take home an additional $7200 a month. So, with your associate job and 70% overhead in your own practice, you will be living on $12,800 a month. Take out taxes, student loans, and retirement, and you will probably be around $4,000 a month cash to live on. Not that bad. You can live a good life on that.

    Now, that would just be the first year. They say your income would go up 10% every year. Figure that in, and in year two you a lot more money to do what you want to, year three more etc. Technically your income would increase more than 10% too, because your retirement amount, student loan amount, office loans do not increase from year to year, so you fun mon would go directly to you and not to those expenses (unless you wanted to pay them off early).

    So, having cash flow is very, very important, and as someone said, if you are not a strong leader, scratch might not be for you. BUT if you are smart, work hard, and have vision, it is very doable with the decent lifestyle.
     
  17. diagnodent

    diagnodent Member
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    All your plans sound good for a starup until you realize that by starting with no immediate cash flow and only working one day a week how are you going to pay for the overhead of a new practice to exist. By only working one day a week you are severely limiting your growth rate b/c the general population needs to have multiple options in days they can come in. By working as an associate you can only make probably $700/day at the most. By working in your own office your office one day may only bring in $1000, but all that money goes to you and paying your office overhead. It makes more sense financially working in your new startup 3-4 days a week and only associating a 1-2 days/wk. That means you will not be earning any money in the first few months.

    Second, starting your own office from scratch takes a lot of leadership skills. You have to design it, direct the contractor, start a marketing campaign, buy everything, hire everyone, etc.

    I bought an existing practice and have transformed it to my vision easily and have had a large income from day one. And it hasn't been that hard. I have friends who started from scratch and had to sign up with all the ins plans and state sponsored ins plans to make money. My advice is by an existing practice a year after graduating and not startup right out of dental school.
     
  18. armorshell

    armorshell One Man Freak Show
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    You might want to reread johntara's post, because that's the exact split he recommended. :D
     
  19. diagnodent

    diagnodent Member
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    Sorry, but I started my post before johntara's was posted. I had to do something in between starting the post and pushing the post reply button.

    His idea is similar to mine, but he does not know the true overhead of a dental practice. You have to figure a 300-350k graduated dental loan will cost you at least $2500/month the first 6 months and then go up from there. As a start up you have rent of 4k, salaries 3-4k supplies 1k, lab fee 1k, insurance 300, professional services 300, utilities/phone 1k, misc 2k, plus others I'm forgetting about. You will have expenses of around 16k a month just for overhead--not including your much needed marketing which should be about 4k/month. You have to make at least 20k but more likely 25k before you can take a profit. That means at 1k/day in your own office 16 days a month leaves you 4-9k short of meeting your overhead. Your overhead will be a much higher percentage in the beginning due to limited practice collections. And your overhead will only increase as you grow due to your dental loan increasing, getting more supplies, higher lab fee, and more employees. So you may not make a profit until 12 months into the startup. That means if you are working 2 days a week as an associate you are making proably 1k a week and 4k a month which is what you will live off. Not much income.

    I try to convice every young dentist I know to buy an existing practice b/c most are dentists are not business savvy. And opening up your own practice takes a lot of business knowledge and training if you want to be successful right away. And by "success" I mean earning at least 150k in your first year. If you can't make 150k in a startup then you should buy an existing office and grow it b/c more than likely you can easily make 150k without much effort. Every year you aren't earning a dentists average salary you are short changning yourself.
     
  20. gould409

    gould409 Junior Member
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    Isn't it much more expensive buying a practice than starting one?
     
  21. jackbauer!

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    Yes... but when you buy a practice you are also buying the patients that use that practice.

    So, unless you have what it takes to market your practice to sustain enough patients to turn a profit despite your high overhead, then you should prolly consider buying into a practice. (re-read diagnodent's post)

    jb!:)
     
  22. Rezdawg

    Rezdawg 1K Member
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    Its also important to note that you are not retaining all the patients if you buy an existing practice...a good portion of them were going to that specific dentist, so many will no longer be coming back.
     
  23. mg777

    mg777 Tooth Mechanic
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    rezdawg i want to bring a counterpoint here. A dentist selling his practice may first get an associate and then phase himself out slowly over time and let the patients get acclamated to the new guy. While the old gp cant force his patients to see the new dentist, he could have the front desk do something like

    "well the old dentist is busy at that time, but we have a new young stud who could see you then? Would u like to give him a try?" And so on, as being a an affable fellow you start swooning patients. There are a lot of ways to work a practice transitiion so the new GP maintains many of the old patients, they happen all the time.

    I'd like to hear what Dr Jeff has to say on the case of a retiring a GP and bringing a new Associate w/ plans to sell and then retire in a few years.
     
  24. diagnodent

    diagnodent Member
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    It would be great if you could associate at the practice you are going to buy a few years before you buy it. However, it is highly unlikely to happen or work out. The reason is that most assoicateships are doomed from failure from the very beginning. The old guy has plenty of patient charts b/c he's been in his office for 20-30 years. He wants to cut back a day or 2 a week and bring an assoicate in and then sell the practice to that associate. So the doctor brings in an associate and gives the associate all the problem patients, the low production items, and prophies (the old doc says do the prophies so you can get better acquainted with patients). The problem is as an associate you want to bring in a good income and can't make a good income doing the little stuff. Most older practices aren't well run enough and don't have the business sense to know how to incorporate a new associate. So what happens is that you had this great practice that you could buy in 3 years for an inflated price that you helped create and didn't make a good income while helping to build it. And on top of that the old doc wants to sell you his office and then work for you for 2 years. The old doc still gets the good hours, patients and still runs the practice. It is very hard for this scenario to work out fairly for you the new doc.

    If you buy an existing office that does average production of 500-700k/year it can only handle one doc so you must get the old guy out ASAP.
     
  25. Rezdawg

    Rezdawg 1K Member
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    I agree. I was just making a point against buying a practice and working as the sole practitioner...if a gp wants to buy into a practice and slowly phase out the initial dentist, then that takes time and is different than just buying an existing practice and working on your own.

    The good thing about dentistry is that there are a million and one ways to go about doing something...therefore, every person will have a chance to go about doing something in a way that makes them most comfortable. As Ive said, Im only finishing up my 2nd year, so I dont know sh!t and am trying to learn as much as I can before my time comes up and I have to start making those real life decisions.
     
  26. airwolfrocks999

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    That's true but there's something else. You have to try to realize why you want to have your own practice. ( I'm referring to general dentists; I don't know about specialists )

    If it's because you don't want to work for younger dentists as you get older ( this is a big one; no one can deny the generational ego. You won't realize it if you're young ) or if it's because you want something of your profession to last, then it's pretty understandable as to why you'll want to buy an office.

    But desire for higher income is not a great reason for wanting to buy an office. The ~30k bump in income doesn't justify being in more debt, having to manage supplies/staff, and having something that's even a bigger liability.

    Again, I can't speak for specialists but they're often in a better shape than general dentists.
     
  27. OceanBlue

    OceanBlue HA! I knew it.
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    even then....you should expect a drop in the number of patients.
     
  28. OceanBlue

    OceanBlue HA! I knew it.
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    diagnodent,
    Great post! I agree that it does take more business sense to start up one from scatch. However, I just want to point out there are many people who started out from scatch and start looking at positive numbers within the first couple of months.

     
  29. johntara04

    johntara04 Member
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    You are right. I don't know specifics on overheads, but I do know that some of your estimates are way high. Maybe you are just in a more expensive part of the country. But, 3-4k a month on salaries for a 2 op scratch start is way too high. You don't need that many employees. Also, 4k for rent is outrageous where I am. 4k a month will buy you a 4,000 sq ft house where I live. So, I guess an important aspect of scratch starting is picking an area where you can afford to scratch start, and making sure you are not wasting money on things that you don't need.

    It is hard to fail in dentistry, that is why the banks are literally throwing money at you. There are a lot of practices that are profitable within a couple on months, and there are a lot that are not. You need to be smart in what you do (as with anything). Only buy/pay for what you need, and do it in an area where you are needed.
     
  30. diagnodent

    diagnodent Member
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    Sorry to burst your bubble, but I was underestimating probable rent being 3-4k. Commercial rent and residential prices are different. A 2 op practice is going to need room for growth so you are renting about 2000 sqft for 4-5 ops. If you want good visibility in a good location (strip mall) in a growing area it is not uncommon to pay about 6-7k for rent. You must remember that if you are building out your landlord is giving you TI's of anywhere from $5-30/sq ft. Salaries can't be much lower than 3-4k unless you don't hire anyone or your spouse works for you. You don't know anything so you probably have to hire someone with experience that may cost you 25/hr (could be lower if you have great systems in place) for 40 hrs so they can answer phones, etc, an asst at 15/hr for 30hrs, and then pay for their health ins.

    BTW, my dental account thinks I'm an expert in dental business and he has over 250 dental accounts. I have also helped numerous friends open up now successful offices.
     
  31. JavadiCavity

    JavadiCavity DDS 2008
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    Sure..you'll have some attrition, but not enough that it should be a factor when deciding to purchase or start-up. I'm happy to have patients who were loyal to Dr. X take a walk for a couple of reasons. First, they are probably use to Dr. X's philosophy which will certainly vary from mine. Second, those patients might never think I match up to Dr. X, which is the last thing I need to worry about right after graduation. And, there are more reasons.

    I'm in favor of buying a practice from a retiring dentist. You get the goodwill, the trained staff, the proven office processes and workflow, and the immediate cash flow. With a start-up...I think you have to juggle too much too soon. Not really an option for me. No way I'm spending 5 years to get my start-up practice up to the level I could have been at had I purchased a practice.
     
  32. johntara04

    johntara04 Member
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    Like I said, prices are different in different areas. If you pay an experienced FD person 25/hr here, you are WAY overpaying. You can get a FD person with 10 years experience in dental here for 15/hour. Assistants (CDA) go for about 8/hour. To get benefits from a doctor here is amazing. Most don't give you anything. Not fair, but that is what the market dictates. Just because it costs you one thing doesn't mean in another area it is the same. We are comparing apples to oranges. Like I said in my previous post, this is a great example as to why you need to check out the locations where you want to practice and see the costs are when deciding whether to start up scratch or buy an existing practice. Some areas are better for scratch, while others you'd be insane to scratch start a practice. Picking the right area to practice can be the difference from being completely out of debt in 3 years (school, house, practice) and struggling for 10 years.
     
  33. diagnodent

    diagnodent Member
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    John you are right about costs being different in different areas. But the majority of dentists don't want to work in a small town where everything is inexpensive, most want to live in med to large cities. My costs are averaging what is about typical of a medium city--500k-1mil people. You are right that paying 25/hr for front desk is not a good idea (i don't even pay half that), but dealing with inexperienced dentists on this board you have to open their eyes up to the potential costs. I know plenty of people who have startups with FD at 25 b/c they aren't great at the business side.
     
  34. Rube

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    And I wouldn't worry too much about high rent. Its high for a reason. The biggest factors in high rent are visibility, as you said, and convenience (parking), but they make money. If I were this guy I'd be more concerned with overpaying for the pt base or for equipment.
     
  35. EHA DDS

    EHA DDS Senior Member
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  36. johntara04

    johntara04 Member
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    All good points.
     
  37. DrJeff

    DrJeff Senior Member
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    Lets say that the practice you're going to buy has 1000 actice charts (not an unreasonable number at all, and if anything rpobably a bit low). Now if 50% leave when the old doc retires, you still have a starting patient base of 500 patients to get you going. Not a bad option compared with a "from scratch" start-up:thumbup:
     
  38. DrJeff

    DrJeff Senior Member
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    Yup, small town dentistry is just a horrific thing;):D:laugh:

    $25 for a FD person, well maybe if your total hourly budget for a FD was $25 and you had around 2 of them, that might be a more reasonable number(atleast in my small town neck of the woods.

    I do find it interesting when I get together with my classmates now 10 years out that generally speaking those of us that practice in small towns are more successful and have less apparent stresses in our day to day than those that went into practice in urban/suburban areas:idea:
     
  39. Dutchboy

    Dutchboy Senior Member
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    How would you define "small town"? Under how many residents?
     
  40. DrJeff

    DrJeff Senior Member
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    The town that I practice in has just under 10,000 folks living in it(town size is roughly 20 sq. miles). The county that its located in has just over 115,000 in it (county size is just under 525 sq. miles. The town I live in (a couple of towns away from where my practice is has a population of just under 8,000 spread out over just under 30 sq. miles of land.

    Basically, a small town in my loose view of things tends to be one where agriculture and small business is the major economic players. Figure less than 10,000 population.
     
  41. johntara04

    johntara04 Member
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    Dr. Jeff, don't give away your secrets. At least not for another 10 years. By then I will be well established, and not as worried about competition. :D
     
  42. I'mFillingFine

    I'mFillingFine Pulptastic
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    When buying a practice from a retiring dentist, how much of the staff does the new dentist usually retain? I imagine some may choose to leave when Dr. Geriatric does (which, like you said for the patients, may be a good thing if their philosophies are totally different than yours.) Otherwise, are staff members usually pretty adaptable?
     
  43. DrJeff

    DrJeff Senior Member
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    Thats totally upto you as the new boss. very often, you'll start out keeping the full "old" staff for both convienance and patient familiarity and then over the coming months/years, you'll realize who is/isn't a "good" employee for you and your style of running the practice and make changes as needed.

    Sometimes, you'll end up completely "cleaning house" and hiring a full new staff. Other times, you'll see the entire staff of the "old doc" celebrating a "10 years in practice" with you milestone.
     
  44. DrJeff

    DrJeff Senior Member
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    Thats the great thing, so many small towns, relatively so few small town dentists. Afterall, not every dentist enjoys the rural lifestyle(fortunately for me;):thumbup::hardy:)
     
  45. DDSwithAplan

    DDSwithAplan New Member
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    The free stuff is a nice idea, but it never works. tHERE ARE SOME THINGS THAT DON'T COST A LOT AND YOU ALREADY HAVE THEM.

    :laugh: Read a few books, The Art of the start is a good one to start with and will give you a lot of references of others

    :) right the pitch first, you can go to a power point template and put together the basic of what you are trying to say or do, then you will have some direction

    :rolleyes:Right the executive summary first and keep refining it until you can put it a one page format

    :confused: Buy or borrow a version of Business Plan Pro, you will have a template that has worked for a lot of people, you can cut and paste from others built in plans once you know were you are going

    :luck: Writing a business plan is a big deal and it has to be yours, even if I gave you mine, it would not do you any good because it almost has to a part of you, making you a part of it would be easier and probably a better experience, but it does not seem to be your direction

    :hardy: you are on the right track, but don't look for a magic pill, just like anything else, it takes a lot of work to get it right
     

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