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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.

General forms



National Voter Registration Act forms



Voucher stock and printer supply order forms



Assessment forms

Health questionnaires​ ​
Infants and children (57-617)   English   Spanish                                ​

Pregnant women (57-618)

English   Spanish
Postpartum women (57-619)    English   Spanish
Diet questionnaires​ ​
Baby (57-622)                     English   Spanish                         ​
Child (57-624)  English   Spanish
Woman (57-626)     English   Spanish



Participant notification forms



Medical documentation and formula warehouse   



Growth charts and weight gain grids


Growth charts
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
Prenatal weight gain grids (57-611, 612, 613)

    Shopper education materials for participants