Client Online Intake Packet

Getting Started

This is a multi-step form that you'll need to complete to start the wig purchasing process.

You will receive a copy of the Compliance Assurance Notification and Customer Bill of Rights forms that are at the end of this form.

Before we start, we need a few documents from you. You can scan these files or take pictures and upload them.

• • REQUIRED: Your Driver's License or Photo ID.
  • REQUIRED: The front and back of your Insurance Card(s).
    NOTE, upload copies of ALL INSURANCES, PRIMARY AND SECONDARY. We need a copy of your primary insurance even if it does not cover wigs.

Upload these files into the appropriate blocks below. If you are unable to upload the files, complete the Printable Client Intake packet.