_______________, D.D.S. / D.M.D. (hereinafter referred to as "Buyer"), understands and agrees that any and all information provided to Buyer by Practice Impact, Inc., the business representative for the selling doctor, at any time is confidential ("Confidential Information") and may not be used in any manner by Buyer or his agents, assignees, legatees, heirs, or other legal representatives, without limitation. Buyer agrees that he will not directly or indirectly, in whole or in part, disclose, use, disseminate, or in any manner publish to any person, firm, partnership, association, corporation, business or professional organization, entity or enterprise for any reason or purpose whatsoever said Confidential Information, nor shall Buyer make any claim or right or ownership to any Confidential Information.

     For purposes herein, "Confidential Information" shall include, without limitation, any and all information relating to the practice operations, employees, personnel and business relationships, proprietary, unpublished data and documents describing inventions, secret processes, technical information, methods, research and other know-how, patients and/or prospects, terms and conditions of sales and practices, business plans and financial information, technical knowledge relating to patient requirements, and knowledge of markets for the business' products. All Confidential Information disclosed hereunder is a valuable, special and unique asset of the business, disclosure of which would cause immediate and irreparable injury, loss and damage to the business.

     Buyer may disclose Confidential Information hereunder to employees, his representatives and/or agents of Buyer on an "As Need To Know" basis, provided that such employees, representatives and/or agents first agree in writing to be bound by the terms of this Agreement. Buyer hereby indemnifies and agrees to defend and hold harmless the selling doctor (and his professional corporation) and Practice Impact, Inc. from and against all loss, cost, damage, liability and expense caused, directly or indirectly, by a breach by Buyer of this Agreement.

     By executing this Agreement, Buyer agrees to receive Confidential Information which may include the Business name which Practice Impact, Inc. is representing under the terms set forth above. Buyer agrees that Facsimile transmissions shall be acceptable as binding. Buyer agrees that Facsimile transmissions shall be acceptable as binding.

     If you agree to the foregoing, please confirm this by signing and returning to Practice Impact, the business representative, this Agreement.

     This Agreement constitutes the entire Agreement with respect to any Confidential Information provided and supersedes any and all prior understandings, or representations, or agreements. This Agreement shall be construed and the rights of the parties governed under the laws of the State of Ohio.

     I agree to the terms and conditions set forth in this Confidential Non-Disclosure Agreement, this ______ day of _____________________, 2005.

Please Print:
Name ________________________                    (Buyer Signature)
Street ________________________                    __________________________, D.D.S./D.M.D.
City _________________________
State, Zip _________ ___________
Home Phone _____-____-________