Phase 1: Application

Eligibility

To be eligible for our program, you must meet the following criteria:

• Is your child between the ages of 3 and 18?

• Does your child have medical-related hair loss?

• Are you seeking a full-cap (whole head) hair system for hair loss?

• Is your child located in the US or Canada?

• Are you willing and able to follow a several-step process to participate in the program?

• Do you understand that the program will take several months to complete?

• Has it been at least a year since you last participated in our program?

If you answered YES to all these questions, please complete and submit the online application form below.

Note: Only a child’s legal guardian can submit the online application for the program. Please choose one guardian to navigate your family through this entire process.

What Happens Next?

After you have completed your application, you will be prompted to schedule an intake interview.  This interview is required to move forward. During this process, we will review some basic information and prepare you for the next phase.