• 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
  • Format: (000) 000-0000.
  • Are you an established client with Loving Arms?*
  • What Are You Looking To Do Today?*

  • 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

  • You are requesting to cancel your Wig Room appointment. Submitting this change will cancel your scheduled appointment and make that time available to another guest.

    Please click "Submit Request" below to complete your cancellation.

  • You are confirming your Wig Room appointment.

    Click "Submit Request" below to confirm your appointment. A text message will be sent to your phone number with your appointment details and our address. 

  • You are requesting to reschedule your Wig Room appointment. By submitting this change, you are giving up your previously scheduled appointment time and replacing it with the new date and time selected above. Your previous appointment time will become available to another guest.

    A confirmation text with your updated appointment details will be sent to the phone number on file.

    Please click "Submit Request" below to complete your reschedule.

  • 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?*
  • Wig Length*
  • Wig Color*
  • Hair Texture*

  • Additional No-Cost Supportive Care Items Available
    Thanks to the generosity of our donors, we often have additional items available at NO COST for patients and caregivers, including:

    • Mastectomy Bras***
    • Breast Forms / Prostheses***
    • Knitted Knockers
    • Compression Sleeves
    • Wheelchairs
    • Walkers
    • Rollators
    • Transport Chairs
    • Shower Chairs
    • Bedside Commodes
    • Canes
    • Crutches
    • Socks
    • Gloves
    • Blankets
    • Pillows and Comfort Items

    And more! If you need it, ASK! We may have it available for you at NO COST.

     

    ***Please know what size you are looking for. We cannot measure you in office. Forms are not by the standard bra size but by a number. Please be sure to get measured before arriving to your appointment. Thanks! 

  • Acknowledgment & Release

    I understand that items provided by Loving Arms Cancer Outreach (LACO), including wigs, head coverings, supportive care items, and durable medical equipment, may be donated and are provided at no cost. I understand that LACO does not guarantee the condition, fit, safety, effectiveness, or suitability of any item. I understand that LACO staff and volunteers do not provide medical advice or determine whether an item is medically appropriate for me. I am responsible for consulting my healthcare provider when appropriate before using medical or supportive equipment.By accepting items from LACO, I voluntarily assume responsibility for their selection and use and agree to release and hold harmless Loving Arms Cancer Outreach, its staff, volunteers, officers, and affiliates from claims arising from my acceptance or use of these items, to the extent permitted by law.
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