Register to get support for your Restless Legs Syndrome

Use the form below to get support, guidance, and helpful tools from the Patch Partnership Program.

All fields are required

Gender:
Have you been diagnosed with Restless Legs Syndrome?

Rank the questions below on a scale of 1 to 11.
1 = not at all; 6 = somewhat; 11 = extremely

Are you currently taking NEUPRO?
For how long?

By providing this information, you are representing that you are a US resident at least 18 years old and giving UCB, Inc. and its business partners permission to send you information regarding your disease as well as information on other related treatments, products and services, and for marketing and informational purposes. You understand that UCB or its business partners will not sell your name, address, email address, or any other information to another party for their own marketing use. You may remove yourself from the mailing list at any time by clicking "unsubscribe" on any e-newsletter or other communications that you receive. You may review the UCB privacy policy at any time at www.NEUPRO.com.