Returning client (New)

Returning Client Cranial Prosthesis Order Form - TRUE by K. Nicole®

This form helps our care team document the specifications for your next cranial prosthesis.
TRUE by K. Nicole™ Specialty DME Provider I Cranial Prosthesis Solutions P: (912) 602-4953 F: (912) 452-1171 E:info@truebyknicole.com W: truebyknicole.com
Welcome back to TRUE by K. Nicole®.

This form allows our care team to document the details for your returning cranial prosthesis order. Because you are an existing client, many of your measurements and preferences may already be on file. This form helps us confirm your current selections and note any updates to your desired length, style, construction, or customization details.

Your responses will guide the fabrication process and ensure that your next unit is prepared with the same level of precision, comfort, and care you have come to expect.

Please provide as much detail as possible when completing this form. If your care plan involves insurance reimbursement, these specifications may also be referenced in the documentation prepared for your claim.

If you are unsure about any selections, you may leave notes for our team and we will review them with you before production begins.

Thank you for continuing your care journey with TRUE by K. Nicole®.
Name

First NameLast Name
Returning Client – Existing Measurements On FileReturning Client – Measurements Need Updating
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Select Cranial Prosthesis Tier
Cap Size?
Notes on Size Adjustments
Any changes since your previous unit?
Please describe where you would like the ends of the hair to fall (for example: chin, shoulders, collarbone, mid-back). Our care team will use this information to recommend the appropriate bundle length and number of bundles for your cranial prosthesis. If you already know the bundle length you’ve used in the past, you may include that as well.
Parting Preference
Styling Details
Example: Bob, Long bob, Layered & curled, textured hair, Straight sleek finish
Top Type
Top Size
Cap Type
Cap Construction Details
No ear tabs, Adjustable straps, Glue-less elastic band
Color Notes
No color, Natural black, #4 with highlights, Custom dimensional color
Customization Notes
Example: Hairline customization, Density requests, Texture blending, Highlight placement, Specific inspiration photo notes
Payment Type
Additional Notes for TRUE Care Team
Client preferences, Special care considerations, Medical sensitivities,
Upload inspiration photo(s) or changes to style.

Cancelof
Thank you for trusting TRUE by K. Nicole® with your continued care.

Our team will carefully review your selections and follow up with your personalized estimate and next steps. Because each cranial prosthesis is crafted with precision and attention to detail, orders are processed in the order they are received.

Please note that production begins once your deposit or insurance authorization has been confirmed.

We are honored to continue supporting you on your journey and look forward to creating your next unit with the care and quality you expect from TRUE by K. Nicole®.
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Returning Client Cranial Prosthesis Order Form - TRUE by K. Nicole®