Non-physician Clinicians 2014 QRS Registration Page

To register for and purchase the AAD’s 2014 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:
Password:
Retype Password:
Attestation
Select attestation file:
(Max File Size 10MB)