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WIC Clinic Forms
On this page ​
 

 

This page contains forms and documents intended for use by local WIC staff in clinic operations.

 


Review tools 

Review tools are now located on the WIC Coordinator page.

 

 


Participant notification forms

 

​Title Print​ available ​Electronic only ​
Participant signature form (57-629)

English
Spanish

Arabic
Chinese
Russian
Somali
Vietnamese
Rights and responsibilities (57-630) English
Spanish
Arabic
Chinese
Russian
Somali
Vietnamese

 

 


Documenting proofs

 

​Title Print​ available ​Electronic only ​
What proof to bring to WIC (57-632) English
Spanish
Arabic*
Chinese*
Russian*
Somali*
Vietnamese*
*updated translations coming soon
No proof form (57-633) English/Spanish    
​WIC proofs checklist (57-634) English/Spanish

 

 


Medical documentation and formula warehouse  

 

 


National Voter Registration Act

 

 

 


Assessment forms

 

Health questionnaires​ ​ (online or in TWIST only)
Infants and children (57-617)   English Spanish

Pregnant women (57-618)

English   Spanish
Postpartum women (57-619) English   Spanish

 

 

Diet questionnaires​ (online or in TWIST only)
Baby (57-622)  English Spanish
Child (57-624)  English   Spanish
Woman (57-626)​  English   Spanish

 

 


Growth charts and weight gain grids

 

Growth charts (online or in TWIST only)
Preterm Infants  
Boys and girls (57-675)                     ​
Birth to 24 months
Boys (57-676)      Girls (57-677)
2 to 5 years   
Boys (57-678)     Girls (57-679)

 

 

Prenatal Weight Gain grids (online or in TWIST only)
Prenatal weight gain grids (57-611, 612, 613)

 

 


Miscellaneous forms

 

 

 


Shopper education materials for participants 

 

​Title Print​ available ​Electronic only ​
Shopping with your eWIC card (57-1002)

English
Spanish

Arabic
Chinese
Russian
Somali
Vietnamese
​Using your Oregon eWIC card (57-1008) ​English
Spanish
Arabic
Chinese
Russian
Somali
Vietnamese
​​Shopping for baby foods (57-1019) ​English/Spanish
WIC foods (visual teaching tool) English
​Shopping with eWIC self-paced lesson English Spanish
​I couldn't buy it with eWIC! English/Spanish ​
  

 

Other shopper education resources: