Wig ER Intake — The Wig Medics
Your name
*
Email
*
Use the same email as your crown prescription so we can match your photos
Intake reference
*
Copy your WIGER- reference from Step 2 of the Wig ER
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
What's wrong with your crown
Current-condition photos
*
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of
Inspiration photos
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Driver's license photo — for intake verification only, kept with this intake only
*
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Desired part / finish
Maintain original style
Bone Straight
Body Curls
Loose Waves
Deep Waves
Defined Natural Curls
Bob
Other
Notes
Delivery
Mail-in
Local drop-off
Submit
Should be Empty: