Medical Wig Consultation Form Elite Hair & Beauty Supply LLC CRANIAL PROSTHESIS; Laketta Gill PHONE: (228) 337-2834 EMAIL: info@elitehairbeauty.com What colour of wig are you interested in? BlackDark BrownLight BrownStrawberry BlondeBlonde HighlightPlatinum BlondeRedGraySalt And pepperSilverWhiteNot sureOther Have you worn wigs before? YesNo Do you have any skin or scalp sensitivities that affect your ability to wear a wig or wig cap? YesNo Client Signature Date
