Apply to Manage Your Facility

Create your account and submit your facility's application in one step

This form does two things at once: it creates your QSS account, and it submits your facility's information for review. A moderator will verify your request — which may include a short phone call to confirm your role — before your account is connected to your facility. Once you submit, you'll land on your dashboard right away; your facility itself isn't instantly approved or claimed.

If you are a human, ignore this field

Create Your Account

First Name

Last Name

Username

Password

Password Confirmation

Facility Application

Tell us about your facility below — a moderator will review and verify your request.

Facility Name

Street Address

City

State

ZIP

Facility Phone Number

Official Facility Email

Your facility's own email address — not your personal email above — helps a moderator verify your role.

Verify Your Role

Best number to reach you

In case a moderator needs to call to verify your role at this facility.

Propose a few times you're available for a short verification call

Optional, but it helps a moderator reach you faster.

Option 1

Option 2

Option 3

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