CHOMARE MEDICAL WIGS · PRE-ORDER

Find Your Perfect Medical Wig

Complete this short pre-order form to help us create a comfortable, natural-looking wig based on your preferences.

No medical diagnosis is required to submit a pre-order.

Customer Information

Please provide your contact details so the Chomare Hair team can contact you about your medical wig request.

Preferred Contact Method *

Wig Preferences

Choose the options that best describe the wig you would like.

Hair Texture *
Density
Cap Size
Parting Preference
Would you prefer a glueless wig?

Head Measurements

For the best fit, please provide your measurements in inches. If you're unsure, select “I need help taking my measurements” below.

Desired Look

Accepted formats: JPG, PNG or HEIC.

Insurance / Documentation

Will you need documentation for possible insurance reimbursement?
Insurance coverage varies by plan. Chomare Hair does not guarantee insurance coverage or reimbursement.

Customer Confirmation