Healthcare Providers
WIC counts on healthcare providers to refer WIC-eligible families to the WIC Program. This page is devoted to giving health care providers the information they need to help us serve our participants.
Important Documents for Medical Providers
Click below to access any referral forms that you are in need of.
We appreciate any referral you may have to our program and our services.
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Referral Forms
Click below to access any referral forms that you are in need of.
We appreciate any referral you may have to our program and our services.
Referring to our WIC Program (for community organizations):
Please fax this Multi-Agency Referral form to us and we will call the participant to discuss their eligibility.
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Medical Documentation Requirements
Medical documentation is requested from the health care provider to encourage participants to seek regular check ups. In many cases, height, weight and hemoglobin screening (Mazimo Pronto device) can be done at the WIC site as well.
WIC requires participants to provide:
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Proof of pregnancy (if applicable)
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Height and weight measurements
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Pregnant Women – 1-2 times during their pregnancy
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Postpartum Women – once during postpartum period
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Infants at enrollment and at 6 months of age
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Children starting at 1 year of age 1-2 times per year
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Hemoglobin results to screen for iron deficiency anemia
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Pregnant Women – once during their pregnancy
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Postpartum Women – once during postpartum period
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Children starting at 1 year – once per year
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When completing the Pediatric referral form, in Section 1, please also complete the lead and immunization status.
Medical documentation is also required for therapeutic formulas
(please refer to Formulas Provided by WIC and the Guidelines for Prescribing Therapeutic Formula at the top of the page for more information).