Download the Form
If you or a loved one is experiencing hair loss due to medical conditions such as alopecia, chemotherapy, or other treatments, a cranial prosthesis can provide both comfort and confidence.
To begin the process, your physician will need to complete a referral form recommending cranial prosthesis as a medically necessary solution.
Download our easy-to-use Physician’s Referral Form today and share it with your healthcare provider. This form ensures that your cranial prosthesis is recognized as a vital part of your treatment plan, and it may also help with insurance coverage.
Start your journey toward renewed confidence—download the form now and take the first step toward obtaining your cranial prosthesis.