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Request Form: QR Stand for Patient Reviews
Enhance your online presence by making it easy for patients to leave reviews. Complete this form to request a
QR Stand
, which will direct patients to your RateMDs rating form with a simple scan.
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* Indicates required question
Email
*
Your email
Doctor's name
*
Your answer
Ship to name (optional)
Your answer
Shipping Address:
Street Address.
Unit Number (if applicable).
Business Name (optional). City. State/Province. Zip/Postal Code.
*
Your answer
Shipping phone number
*
Your answer
The QR Stand measures
10.2 x 15.2 cm
. Please allow
2-3 weeks
for manufacturing, shipping, and delivery.
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