Insurance Forms

Please provide the neccessary items listed below in order for us to file your insurance claim:


1. Copy of your insurance card. (Front & Back)


2. Your doctor's prescription
How do I get a doctors prescription?


3. Completion of the Patient Registration form below.


Patient Registration


4. Fax your insurance card and doctor's prescription to this fax number: 

FAX: (434) 792-1605

Insurance Information



Most people don't realize that insurance will cover wigs for those battling hair loss from a medical condition. Typically, the provider will cover the cost of wigs for you. You may get your physician to write a prescription for a wig due to "Hair prosthesis for alopecia from chemotherapy due to (cancer diagnosis)."

Follow the step on the left or bring us your prescription for your cranial hair prosthesis, and we will take care of the rest.

We file your insurance for you!

Call now for your custom fitting at 276-632-3198.