Please read before starting your application. This is a TWO PARTS process. Step 1 is right below. Please scroll down for Step 2 (completing our form). If you are unable to meet BOTH requirements at this time, we kindly ask that you wait to submit your request until you can.

Step 1 of 2

We will only process requests once BOTH PARTS have been submitted.

Please send us an email at connect@thebutterflyclub.org with the following items attached so we can process your wig request as quickly as possible.

Please attach the following:

  1. A photo of your head without hair
    Please send a clear photo showing your head without hair. This is to avoid fraudulent requests as we do not send wigs to women or teenagers who have hair.

  2. A photo showing your treatment port
    Please upload a photo of your face showing your treatment port.

  3. Medical verification

    Your medical information is kept completely confidential.
    Please upload either:

    • Aletter confirming your cancer diagnosis, or

    • A medical summaryfrom your healthcare provider.

      We do not need any other medical information.

  4. Your preferred wig style

    Please upload a photo of the type or style of wig you would prefer. This helps us better match you with a wig you’ll feel comfortable and confident wearing.

All information and images shared with us remain private and confidential and will never be posted or shared publicly.

We look forward to hearing from you and are committed to helping you. Thank you for choosing us.

Humbly,

The Butterfly Club

Please Email Us Step 1

We will only process requests once BOTH PARTS have been submitted.

Step 2 of 2