Henry Schein One
License Transfer Form
Disclaimer
I authorize Henry Schein One to contact relevant parties for this transaction using the provided contact details.
Transfer or contract changes are subject to both parties’ submission of complete information on a signed 'License Transfer Agreement' provided via Adobe Sign by a Henry Schein One representative.
I understand that changes to account names, contact details, and email addresses in this transaction will update across Henry Schein One systems, including invoicing and patient communications. For confidential transactions, consider delaying any changes until all stakeholders are informed.
Contact our support team at (833) 471-2273 for assistance with changing business or provider information in your practice management software.
Legal documents will be delivered to this address for population and signature. **Must be different than purchaser email**.
Legal documents will be delivered to this address for population and signature.