Wigs and Wishes

Please complete the following form ONLY if there is NOT a participating salon in your area.

If you aren't sure please visit: http:wigsandwishes.org\request-a-wig and use the map to find your closest salon.

If there is a local salon, then please contact them directly to set up your initial consultation.

If there isn't one close to you, then please complete this form and we will be in touch with you shortly.

Thank you!

* indicates required

First Name *

Last Name *

Email Address *

Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Is this request for an adult or a child? *

Adult
Child

Gender of Recipient *

Male
Female
Prefer not to say

Wig Requests