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CRANIAL PROSTHESIS RX TEMPLATE

Please request your doctor to fill out this prescription template for a “cranial prosthesis” aka medical wig and 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.

Please email the completed prescription at april@alelbeautboutique.com.

CRANIAL RX TEMPLATE.jpg

CLICK ABOVE TO DOWNLOAD FORM

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