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BBS Form

Please answer the following questions so we can put you in touch with a Rhythm InTune Patient Education Manager (PEM) for personalized support

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Tell us about you or your loved one’s condition.

Step 1:

Step 2:

*Required information.

What conditions have you or your loved one experienced or been diagnosed with?*

Check all that apply.

Bardet-Biedl syndrome (BBS)

Overweight/obesity

Intense, hard-to-control hunger

Inherited retinal disease

Retinitis pigmentosa

Other vision impairment

Kidney problems

None of the above

Please select an option.

Are you 18 years or older and a U.S. resident?*

Yes

No

This is required.

Are you filling out this form for yourself or a loved one?*

Myself

A loved one

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What is your first name?*

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What is your last name?*

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What is your email address?*

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Please enter a valid email address.

What is the best way to reach you?*

Phone Call

Text

Email

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Is it okay for the Patient Education Manager to leave a detailed message?*

Yes

No

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Is it okay for the Patient Education Manager to send a text message?*

Yes

No

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What is your phone number?*

We use your phone number to contact you about Rhythm InTune services only. We do not sell or disclose your phone number and other personal information collected in the assessment to third parties.

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When is the best time to reach you?*

Morning (8:00 AM to 12:00 PM)

Afternoon (12:00 PM to 5:00 PM)

Evening (5:00 PM to 9:00 PM)

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What state do you live in?*

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