APPLY FOR A HAIRPIECE

If your child needs a hairpiece, please fill out the application and
send the requested information via Certified Mail or your preferred carrier (Federal Express, UPS, DHL, etc.). We need all of this information before the Board of Directors can grant approval.

Send Applications via certified mail to:

Case Manager
LOCKS OF LOVE
234 Southern Blvd.
West Palm Beach, FL 33405

For more information, call us at (561) 833-7332

Trouble Shooting
Locks of Love offers many documents in the form of "PDF" (Portable Document Format) files. These files retain the formatting and graphics of the document for viewing or printing across a broad range of hardware and software. To view these files, you'll need a copy of the free Adobe® Acrobat® Reader® software version 4.0 or above. If you don't currently have Adobe Reader on your system, you can download and install it using the link to the Adobe Web site above where you can also learn more about PDF files.


	INSTRUCTIONS Printout of completed application. (PDF) Medical Information: What is the cause of the child's hair loss? Is the loss of a permanent or temporary nature? Who is the child's physician? Please include a medical diagnosis. Doctor's office may fax information directly to Locks of Love at (561) 833-7962. Financial Information: Please include a copy of the most recent TAX RETURN or if receiving public assistance, please include a copy of state and/or federal benefits. Please include any documents that verify extenuating financial circumstances. Each case is reviewed individually. Personal Information: Please submit a photo of the child without a hairpiece or hat to help us with the custom fit and at least two letters of recommendation from a parent, a teacher, a friend, coach, etc. explaining why the child would benefit from a hairpiece.

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