FREE MEDICAL WIG REQUEST


No one should have to face cancer alone and without the necessary support. That's what QUEEN UCHE FOUNDATION is here for you, we do more than just restore a young girl's or a woman's lost hair, we give them hope, confidence, empowering them to take back their life again and face the world with a smile and a stronger self-esteem.
Our service is free and helps anyone touched by any type of cancer, at any cancer stage level, at any age, living anywhere in the world. If you are or your loved ones are in need of medical wig, feel free to sign up this form.

Please submit this medical wig request form for us to check if you qualify for high quality free medical wig.
Thank you.

Reason For Hair Loss?
AlopeciaBurnsCancer TreatmentsTrichotillomaniaOther medical reasons
Your annual income? We might ask for verification of your income.
Do you have medical insurance? If you have medical insurance we can help you to get wig paid by your insurance company and skip verification process.
YesNoI don't know
NOTE : Comments or story you think we should know?*
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