Information Request Form

If you or someone you know has been diagnosed specifically with alopecia areata, you may request information from NAAF by completing this form (using the TAB KEY to move between fields) and clicking the Submit Button.

We will send you a basic information packet that contains:

  • A letter of introduction
  • A list of NAAF support groups and telephone support contacts
  • Brochure - What You Should Know About Alopecia Areata and the National Alopecia Areata Foundation
  • Brochure - Helping You Cope with Alopecia Areata

If you specify that the person with alopecia areata is under 18, we will send the basic information packet plus:

  • Brochure - Parents Talking to Parents about Alopecia Areata
  • Brochure - Alopecia Areata: a Children's Perspective (written and illustrated by children for children)
  • NAAF newsletter excerpts on raising a child with alopecia areata and promoting self-esteem
  • Information on becoming part of the NAAF Children's Network
  • Two stories from the NAAF newsletter written for young children (if the person is age 13 or under)

To order additional items, please see the physician's order form.

Information Request Form

The National Alopecia Areata Foundation does not share any personal information with anyone outside the organization.

First Name:
Last Name:
Address:
 
City:
State: Zip:
Country:
Phone:
Fax:
E-mail:
Person who has alopecia areata if other than you:   Age (if under 18):
Relationship to you:
Additional requests or comments: