Client Information Forms

To make your visit to Cure & Co. as easy and quick as possible, we suggest you fill out the Client Information Form

If you are planning on using insurance to make your purchase for items such as wigs, bras, and prosthesis. Please send us the following listed below, This way we can check your insurance before you come to your appointment. Please email us all the information to or have it ready on the date of your appointment.

– Client Information Form
– Send a copy of Drivers License (front and back)
– Send a copy of Insurance Card (front and back)
– Prescription from Doctor ( should contain CPT or procedure code, Diagnosis code, DOB, Qty of each item, if it is a prosthesis should mention which side or bilateral)

List of Codes: 
A9282 – cranial prosthesis
L8000 – post- mastectomy bras
L8020 – Leisure or Priform Prosthesis
L8030 – Silicone Prosthesis
L8015 – Post surgical Camisole