QUESTIONS?

CALL 1-844-KYNMOBI 1-844-KYNMOBI (1-844-596-6624), Monday through Friday, 8 AM-8 PM ET

CALL 1-844-KYNMOBI 1-844-KYNMOBI (1-844-596-6624), Monday through Friday, 8 AM-8 PM ET

Complete this form to seamlessly begin the onboarding process for your patient with KYNMOBI® KYNNECT.

Instructions:

Complete this Enrollment Form.

Complete this Enrollment Form

Sign the Prescriber Authorization.

Sign the Prescriber Authorization

Press the Enroll now button.

Press the "Enroll now" button

A KYNMOBI® KYNNECT Case Manager will follow up with you if they have additional questions.

An asterisk (*) indicates this is a required field.

HOW TO ONBOARD YOUR PATIENTS WITH

KYNMOBI™ KYNNECT is specifically designed to help healthcare providers and patients understand and manage the challenges of accessing therapy every step of the way.

KYNMOBI™ KYNNECT is specifically designed to help healthcare providers and patients understand and manage the challenges of accessing therapy every step of the way.

Step 1

Patient Starter Kit

Please select one.

Step 2

Titration and Education Support

Please Enter Instructions.

A Clinical Educator will reach out to your patient and schedule time to conduct their initial visit, and any follow-up visits as necessary, to complete the titration process. After each visit, the Clinical Educator will provide you with a summary.

Please select one.

Step 3

Benefits Investigation

Please select Yes or No.

PATIENT INFORMATION

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CARE PARTNER INFORMATION

PRESCRIBER INFORMATION

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For more information about the collection and use of personal information, please see the Sunovion Privacy Notice .


THANK YOU
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 and text 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: If needed, please submit a prescription for your patient's Patient Starter Kit to Careform Pharmacy

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.

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Thank you for registering with KYNMOBI!

We look forward to telling you more about KYNMOBI, a new medication to treat OFF episodes associated with Parkinson's disease, as it becomes available.

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