APPLY FOR A WIG THROUGH YOUR INSURANCE
How to Apply
- Complete all form fields at the left and upload/attach the following documents. Click on (Attach Requested Document's) below.
- Download and complete fields 1-13 on CMS 1500 form below.
- Upload (Attach) completed CMS 1500 Form.
- Upload (Attach) Recent Doctor's Prescription for cranial prosthesis.
- Upload (Attach) Doctor’s letter of necessity.
- Upload (Attach) Front and back copies of insurance card.
- Upload (Attach) Front and back copies of government issued ID.
Healthcare Wigs
COMPLETE CMS 1500 MEDICAL FORM
Download and Complete fields #1-#13 on the following form
Upload along with other documents above.
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