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  2. Living with cancer
  3. How we can help
  4. Order a wig online
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how we can help

Wig and breast prosthesis services

All Canadians, no matter where they live, can access free wigs and breast accessories with just a simple call or click.
  1. Home
  2. Living with cancer
  3. How we can help
  4. Order a wig online

Order a wig online

Instructions
Please fill out this form and let us know your wig preferences. Based on the information provided, we will email you up to three wig options to select from.

Once this form is submitted, it may take up to 15 business days for someone to reach out to you to proceed with your request. Our primary method of communication is email; please ensure your email address is correct. 

For checkboxes, please check all that apply. Fields marked with an asterisk (*) are required for this form to be submitted
Contact Information



Please note that we cannot ship to PO Boxes. Please provide a valid residential or business address.



Please add appartment address and buzzer code if you have one. This helps us ensure seamless delivery to your apartment/unit.







Wig Preferences


"Short" (chin length or shorter), "Medium" (chin to shoulder length), "Long" (below shoulders)

Please use "More Information" field at the bottom of this form to add additional detail




If you are able to upload a file of your current hairstyle or a wig that you like, we will use this to find a closer match. Accepted formats: .bmp .gif .jpg .jpeg .png .tif .qtf

Privacy Disclosure
We collect your personal information through forms, by phone or in person to manage your participation in the program, inform you about other services and contact you to provide updates about our impact and ways to support us or give.  We may also use your information for program evaluation and quality assurance. We may share your personal information with third parties including service providers, consultants and advisors outside your province or territory or outside of Canada only to carry out the purposes identified above, or as required by law. We may contact you by mail, email, phone or text. You can exercise your right to access your information or have it corrected, unsubscribe from communications or withdraw your consent by calling 1-888-939-3333 or emailing privacy@cancer.ca. For more information about our privacy practices, visit cancer.ca/privacy. 
Ethnicity (Optional)

The Canadian Cancer Society is committed to understanding our impact on various communities. Having the information below will assist us in identifying any gaps in our services and programs, enabling us to address them so we can support more people. Please note that the following questions are voluntary. They can be skipped, or you can select the ‘prefer not to say’ response option if you do not wish to respond.


Additional text box linked to question where a client can submit a custom response to "I am"

Terms and Conditions

Signoff

Note: If not the Client, I confirm have I been authorized by the Client to complete and submit this form and correspond with the Canadian Cancer Society on the Client’s behalf.