Enrollment Form for KYNMOBI™ KYNNECT
CALL 1-844-KYNMOBI (1-844-596-6624), Monday through Friday, 8 AM-8 PM ET
Complete this form to seamlessly begin the KYNMOBI™ KYNNECT onboarding process.
Complete this Enrollment Form
Sign the Prescriber Authorization
Press the "Enroll now" button
A KYNMOBI™ KYNNECT case manager will follow up with you if they have additional questions.
All fields required unless otherwise noted.
for submitting the Patient Enrollment Form.
A KYNMOBI™ KYNNECT case manager will contact you if there are any questions. A separate Patient Support Agreement will be sent to the patient via email for their approval. Please ensure that your patient knows the agreement is on the way. Additionally, patients should be aware that a representative from KYNMOBI™ KYNNECT may contact them via telephone or email in the next 2 days.
Reminder: Please submit a prescription for your patient's Patient Starter Kit to TC Script
Visit the KYNMOBI™ KYNNECT page for more information about the program
If you have additional questions, please contact us at 1-844-KYNMOBI (1-844-596-6624), Monday through Friday, 8 AM-8 PM ET
For more information about the collection and use of personal information, please see the Sunovion Privacy Notice.
Please see Important Safety Information and full Prescribing Information and Instructions for Use for KYNMOBI at www.kynmobihcp.com.