QSPACES Premium Profile Signup

Premium Provider Profile

For providers, practices, and health systems. If you are a patient or client, then please use this form: http://bit.ly/addprovider
Sign up for a Premium Profile - only $3.99 per month!

The purchase of a Premium Profile also includes:
- a 5-star rating on the app from QSPACES. This will help your profile stand out in the list and driving users to your profile and learning more about you and your practice.
- an announcement on our social media (3,500+ followers!), a 5-star rating from QSPACES, and a “Thank you for your support” review. Starting with a 5-star rating and review will drive potential patients / clients to your profile!
If you have any other questions about the Premium Profile or would like to discuss quantity discounts for your entire practice, please email cat@qspaces.org.
Basic Information
Name, Title
i.e. Angela Davis, MD
Pronouns
Email Address *
for QSPACES to contact you, not for patients
Practice Categories *
no more than 3. example: primary care, massage therapist, etc.
Tags to describe you / your practice

Accepts Insurance, Fat Positive, Kink Positive, LGBTQ+ Identified, Person of Color, Sex Worker Competent, Sliding Scale Payments, Trans Competent, Trauma Informed,
Do you provide telehealth or virtual services?

Yes No
Practice Description and Images

Add your practice and personal information into the box or upload a word document. The description can have links, bold and italic text, bullets, etc. The banner image will be at the top of your listing and it will crop to fit. We suggest using Canva as an easy way to build a custom header (headshot with text or image of practice).
Cover Image

Browse Files
approx. 810px x 450px cover image Cancel of
Description of Provider and Practice (or upload a document below with links, bold, bullets, italics, etc.)
links can be included and additional images can be embedded into the profile by providing a link to an image (i.e. a link to a headshot on LinkedIn or another website or hosting platform (like giphy)
Description Files

Browse Files

Cancel of
Additional Information
Practice Address (what you want to show on your profile, and how you will show up on maps - feel free to use an approximate location)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Hours
example: M-F 8am - 5pm
Phone

Area Code Phone Number
Email Address
for patients
Website Link
Facebook Link
Twitter Link
Instagram Link
Social Media Shoutout

Add 1-4 photos in a square frame for best layout across all platforms. FYI, high-quality photos of faces and people are the most likable and engaging! We want you to look good :)
Photo 1

Browse Files

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Photo 2 (optional)

Browse Files

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Photo 3 (optional)

Browse Files

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Photo 4 (optional)

Browse Files

Cancel of
Subscription Selection

Subscription Tiers

LIFETIME - ONE TIME PAYMENT ( $ 99.00 for the first year then, Free for each year )

Pay once for a lifetime Premium Profile! You can still update at any time and will receive access to any and all Premium Profile features in the future. This is a LIMITED TIME OFFER for early adopters and supporters of QSPACES.

Premium Profile - Yearly ( $ 39.99 for each year )

Pay only once per year at a 16% discount!

Premium Profile ( $ 3.99 for each month )

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

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Premium Provider Profile

Basic Information

Practice Description and Images

Additional Information

Social Media Shoutout

Subscription Selection