Special Wig Request

EBeauty Special Wig Request Form

Please complete all sections below to help us fulfill your patient’s wig request. Allow adequate time for shipping before the patient’s appointment. All wigs sent will be deducted from your current inventory.

    Requested Wig Details

    Length:

    Style:

    Bangs Requested?

    Photos (Recommended)

    Photos help us best match your request. Please attach clear images. A photo of the patient’s hair is preferred but if not available, an image of the type of hair / wig she would like will suffice.

    Accepted file types: jpg, png, pdf, fig, jpeg, Max. file size: 1,000 MB, Max. files: 4.

    * Required fields