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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