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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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Email *
Doctor's name *
Ship to name (optional)
Shipping Address: Street Address. Unit Number (if applicable). Business Name (optional). City. State/Province. Zip/Postal Code.  *
Shipping phone number *
The QR Stand measures 10.2 x 15.2 cm. Please allow 2-3 weeks for manufacturing, shipping, and delivery.
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