Wigs for Veterans

Wigs for Veterans

100% No Cost to the Veteran!
Are you a veteran struggling with thinning edges, shedding, patches, or complete Alopecia (Totalis)?Are you frustrated with finding a stylist specializing in Cranial 'Wig' Prosthesis?Are you experiencing Alopecia due to Stress, PTSD, Depression, Age, Lupus, Cancer, Genetics, Military Uniforms/Hats, and much more?
Hair Loss Details - What is the primary cause of your hair loss?
Please select the main reason for your hair loss, such as medical conditions, stress, or service-related causes.
What is the diagnosis causing your hair loss?
If you selected "Other" in the previous answer, you can elaborate here
What is your #1 goal for your Cranial 'Wig' Prosthesis?
(Example: "Comfort, style, restoring confidence, ease of use")
What are your biggest frustrations with wearing wigs?
(Example: "Uncomfortable fit, unrealistic look, maintenance issues")
What would your ideal Cranial 'Wig' Prosthesis look like?
(Length, color, texture, density, etc.)
Full Name:

First NameLast Name
Gender:
Phone Number:
"Please provide a phone number so we can contact you!"Format: (000) 000-0000.
Verify your Email
Branch of Service:
Please select the branch of service you are or were in.
Last 4 SSN:
This is for VA verification purposes
Exact Name and Phone Number of the VA Hospital you have spoken to about your Medical Wig?
If you're unsure of the phone number, please just provide the exact name of the VA Hospital.
Name of VA Contact in the prosthetics department (if known):
This can help expedite the process.
Do you already have a referral/authorization or approved prescription for 2026?
Have you already received a consult/referral from your primary care doctor within the VA Hospital for a custom medical wig due to your hair loss condition.
Upload VA Authorization for 2026

Please provide your consult/referral from the VA.
Cancelof
How did you hear about us?
Please let us know if you were referred by a VA case manager, prosthetics department, or found us through another source Google etc.
PLEASE NOTE: Veterans working with VA Prosthetics or Community Care may request Heavenly Tresses for cranial prosthesis services.
Appointment
Signature :By signing below, you confirm that all information provided is accurate to the best of your knowledge and that you are a veteran eligible for VA-approved benefits.
We are honored to support you on this journey. Your information will be kept confidential and secure. Once submitted, our team will reach out to discuss the available custom cranial prosthesis options and connect with your VA to begin the process.
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