Written by a parent, not a doctor. Nothing here is medical advice.

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Children With Hair Loss

Hair Replacement Program

What you get

Help with human-hair replacement, complete care kit and hair-care support and education. Open now.

Who starts it
You, with a letter from your doctor
How it’s sent
Online, on their website
Your time
About 30 minutes, plus waiting for the letter
Last checked
Aug 27, 2026

Before you start, check you fit

  • Your child is 20 or under.
  • Doctor letter and identity/photo uploads are required.
  • Applicant must be under 21, reside in the United States, and be a U.S. citizen or permanent resident.

  1. Ask your doctor for the letterStart here. This is the part that takes the longest.

    Children With Hair Loss needs a letter from your doctor. It has to cover 4 things. Copy this message, or say it in person at the next visit.

    Hi [doctor’s name],

We’d like to apply to Children With Hair Loss’s Hair Replacement Program. They offer help with human-hair replacement, complete care kit and hair-care support and education, and they are taking applications now.

They need a letter from you. It has to cover applicant name and birthdate, hair-loss diagnosis, date last seen by doctor, and most recent chemotherapy treatment date when applicable. Their form and instructions are here: https://childrenwithhairloss.org/hair-application/

Could you write that when you have a chance? I can send you the link, or bring a printout to our next visit. Thank you for everything you do for us.

[your name] · [phone]
    Copying is the only thing this page does with your text. Nothing is saved.

  2. Fill in their applicationIt is on their website.

    Open their application ↗ Checked Aug 27, 2026

    What the form asks for

    Recipient and contact details
    Recipient Full NameParent or Guardian Full NameRelationship to RecipientRecipient's GenderRecipient's BirthdateRecipient Home Mailing AddressPhone NumberEmail
    Medical, provider, and hair details
    Hair Loss DiagnosisHair Loss Diagnosis DateHospital NameDoctor's NameDoctor's PhoneSocial Worker's NameSocial Worker's PhoneSocial Worker's EmailHave you received a hair replacement from Children With Hair Loss in the pastHead Circumference MeasurementPlease add any comments, concerns or special requestsIMPORTANT: The recipient and anyone helping to care for the human hair replacement has watched the Hair Care videos on this website

    Have ready

    • Applicant identity/age document.
    • Parent or guardian identity document.
    • Before-hair-loss and current hair-loss photos.

  3. Submit it on their websiteSend the letter with your application, or the way they ask.

    • Use the official online Hair Application, upload all required documents and photos, complete the hair-care-video attestation, and submit.

After you send

Email cwhl@childrenwithhairloss.org with questions or extra photos/documents after submission and include your name. If you have not heard back in two weeks, write and ask whether it arrived.

Full record, as published