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Non-physician Clinicians 2015 QRS Registration Page

To register for and purchase the AAD’s 2015 Quality Reporting System (QRS) complete the form below and attach the signed attestation. Once complete, a confirmation email will be sent upon submission.

Registration Information
First Name:
Last Name:
Email Address:
Phone Number:
Practice Address:
Practice City:
Practice State:
Practice ZipCode:
Retype Password:
Select attestation file:
(Max File Size 10MB)