Ready To Schedule Your Appointment?
At our Beauty Room, you’ll find free wigs, hats, scarves, and other beautiful items generously donated by our community to remind you that cancer can never take away your beauty or your strength. We kindly ask that you complete this form to help us better assist you during your appointment.
Client Information:
Please provide the information for the individual receiving services from our beauty room
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
Are you an established client with Loving Arms?
*
Yes
No
When Would You Like To Visit The Beauty Room?
Please select a date and time that suits you to visit our beauty room. Most appointments take about 30 minutes, but we always dedicate as much time as our guest needs to find their perfect wig!
Appointment
*
What Are You Looking For?
Help us be able to find your perfect wig! Please select what you are looking for, or let us know if you are open to new styles! Have a few different ideas? Select ALL you are interested in!
What items are you in need of?
*
Wigs - You are able to take up to 2 home for FREE
Hats -
Scarves
I want to try them all!!
Not sure what I am looking for, but I'm open to something new!
Wig Length
*
Short (ear-length to chin-length)
Medium (Chin-length to shoulder-length)
Long (Past shoulders to mid-back or longer)
I want to try them all!!
Not sure what I am looking for, but I'm open to something new!
Wig Color
*
Natural Colors: Black, dark brown, medium brown, light brown, blonde shades
Gray/Silver: Full gray, salt and pepper, steel gray
Fantasy Colors: Pink, blue, green, purple, ombré combinations
I want to try them all!!
Not sure what I am looking for, but I'm open to something new!
Hair Texture
*
Straight
Wavy
Curly
I want to try them all!!
Not sure what I am looking for, but I'm open to something new!
Please let us know any additional requests:
OFFICE USE ONLY- Front Desk Volunteer Name (if completing by phone)
First Name
Last Name
Release of Liability
I understand that the wigs, hats, scarves, and beauty items provided by Loving Arms Cancer Outreach (LACO) are donated items and are offered free of charge as a gesture of support and encouragement to individuals affected by cancer. I acknowledge that LACO makes no guarantees, expressed or implied, regarding the condition, fit, safety, or suitability of any item I choose to accept.By signing below, I release and hold harmless Loving Arms Cancer Outreach, its staff, volunteers, and affiliates from any and all liability, claims, or demands that may arise from the use or acceptance of any items provided through the Beauty Room.I understand that participation is completely voluntary, and I accept full responsibility for my selections.
Please complete below if you agree to the above statement:
Guest Full Name
*
Today's Date
*
-
Month
-
Day
Year
Date
Signature
*
Schedule Appointment
Schedule Appointment
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