National Alopecia Areata Foundation
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Information Request Form

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

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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 - A Parents Guide - Parents Talking to Parents about Alopecia Areata
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  • Brochure - Alopecia Areata: From a Child's Point-of-View (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)

If you are a Physician or other and would like to order additional brochures, Please download this form, complete it completely and fax to 415-472-5343.

1. Registration Information:

 

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Date of Birth:

 

 

 


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  Information about individual with Alopecia Areata:
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(Maximum response 255 chars, approx. 5 rows of text)

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