Use the online Breast Pump Mailing Label Request Form to request mailing labels from the State WIC Office. See the online form for more details. For questions, please email [email protected] .

Women, Infants and Children (WIC) Program Forms CDPH 247 (PDF) - Medical Formula and Nutritionals Request. CDPH 247 A (PDF) - Pediatric Referral. CDPH 247 B (PDF) - WIC Referral for Postpartum/Breastfeeding Women. CDPH 247 C (PDF) - WIC Referral for Pregnant Women. CDPH 4125 (PDF) - Report Concerning Vendors for Local Agency and Participant Use

Interested individuals or referring organizations can submit this form and a local WIC clinic will contact you. Being on WIC does not make you a public charge and does not affect your immigration status. U.S. citizenship is not required to qualify for WIC.

How to apply for WIC. Public Health offers WIC information and services at locations across King County. Home or off-site visits are also available. Call us for an appointment at a location near you 206-263-9300. or; Fill out this online interest form: …

You get extra foods if you are fully breast and chest feeding and participate in WIC. You can also get: Iron-fortified formula for non-breastfed babies; Jarred baby fruits, vegetables, and meats; Get health screenings and referrals. Through WIC you can also get healthcare appointments to measure growth, height, weight, and blood iron levels.

The Cumberland County Department of Public Health has added a WIC Information Line to free up WIC Appointment Line congestion. For informational questions about WIC, call 910-433-3610. Please note the new line does NOT replace the WIC Appointment Line at 910-433-3730.

This form may be used to refer patients to the WIC Program and to communicate changes in patient health information. The information provided on this form will be used by a WIC nutritionist to determine nutrition care and provide nutrition counseling. A separate form is …

Complete this form to assist the patient with WIC eligibility, WIC services, and appropriate referrals. Hemoglobin or Hematocrit Test is required every 12 months when normal and every 6 months when abnormal. The information above is only for use by the intended recipient and contains confidential information.

Please refer your client to WIC, even if nothing is checked below. This information assists the WIC nutritionist in determining eligibility, developing a nutrition care plan, and providing nutrition counseling.

WIC Referral Forms. Medical documentation is required for WIC participation. Please use this form to assist patients with WIC eligibility. The information provided will be used by WIC staff to assess your patient’s health status and provide nutritional counseling if …