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Please request your doctor to fill out this prescription template for a “cranial prosthesis” aka medical wig and fax/email the completed form back to us. This prescription form includes the medical procedure code A9282 that will be used to submit your insurance claim.
Click here to download the Cranial Prosthesis Prescription.
Please email the completed prescription at email@example.com or fax it to us at (281) 602-5094.