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SMILEZ FOR KIDZ


SMILEZ FOR KIDZ

Smilez for Kidz is a program developed by American Hairlines which provides FREE* hair replacement solutions for children affected by hair loss due to chemotherapy, alopecia, burn accidents and other medical conditions. To qualify, participants must:

  • Be 18 or under.
  • Be experiencing hair loss dues to chemotherapy, radiation therapy, alopecia, burns, or other medical conditions.
  • Provide documentation from a medical professional.
  • Be unable to finance a hairpiece after checking with all other resources including insurance coverage.
  • Be able to travel to our location.
  • Complete Application

    If you feel that your son or daughter qualifies, please fill out the Smilez for Kidz application and call us at 724-935-5200.

    The total process consists of the following:
  1. Filling out the Smilez for Kidz application.
  2. Contacting our office.
  3. Scheduling a consultation.
  4. At the consultation, measurements, design and color will be discussed.
  5. Approximately one to two hours.
  6. Hair will be ordered.
  7. It may take up to 12 weeks for the system to be completed.
  8. Schedule an additional appointment so that we may check your progress and give you any additional maintenance training. * The hair system is free. The only cost for you is that of maintenance and styling products.
SMILEZ FOR KIDZ APPLICATION
Name
Sex *
Male Female
City
State *
Medical insurance?
Insurance company
Policy #
Prosthetic devices covered?
Medical reason for hair loss?
Currently undergoing treatment?
If yes, what type of treatment?
Currently experiencing hair loss?
If yes, to what degree?
Name of doctor
Doctors phone
Hospital / Treatment Center
Parent or Guardian Name
Address
E-mail Address: *
Phone

* Required