Elevate Salon Appointment Request

We know how important it is for you to feel like yourself throughout your cancer treatment.

Our professional team looks forward to helping you with your wig and headcovering selections. Please complete the form below and we will give you a call to schedule your appointment.

Personal Information
Contact Information
May we say we're calling from Roswell Park?

Due to HIPAA regulations, Roswell Park will not be able to identify itself to someone other than you or in a voice message, unless you indicate otherwise.

May we leave a message if you're unable to answer?
Appointment Details

Have you already placed an order for a headcovering, or do you already have your headcovering?

What service is needed? *
Check all that apply

Which stylist would you prefer to see?

Please prepare for your headcovering consultation by looking through our catalog. Available products begin on page 16.

Please select day(s) you are available for an appointment