WIC Referral Forms for Health Care Providers
Referring eligible patients to WIC ensures they receive access to nutritious foods, breastfeeding support, nutrition education, and community resources that directly improve maternal and child health outcomes.
PHFE WIC offers many open-source resources to dietitians, researchers, and other maternal and child health professionals to spark collaboration to improve health outcomes.
To be eligible for WIC services, all WIC participants must provide certain medical documentation, including documentation for formula for premature and medically fragile infants. This includes any special formulas and nutritionals for older children.
WIC Referral Forms
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 they qualify for the program.
WIC Eligible Formulas
WIC provides contracted formulas as part of an agreement that is a federally mandated cost containment system. For infants and children who require a medically necessary (therapeutic) formula, WIC can assist the provider in obtaining certain formulas for their patients.
Help Connect Families with WIC
- Order free WIC brochures to share with your patients (available in English, Spanish, Vietnamese, Chinese, Russian, Korean, Hmon, Armenian, Arabic, Punjabi, and Farsi).
- If your patient requires a therapeutic formula for a medical condition, please fill out the Medical Formula and Nutritionals Request Form.
- Share the WIC website to find the latest income guidelines and other information. Also share our website for WIC families at myfamily.wic.ca.gov.
- Ask patients to call WIC’s automated toll-free line at 1-888-WIC-WORKS (1-888-942-9675), available in 5 languages.
Share local WIC agency information. Families living in Los Angeles, San Bernardino, and Orange Counties can call 1-888-942-2229, or text APPLY to 91997.
Families living in other areas of California can use the WIC Office locator to find their local agency information. Encourage patients to call before they go to their WIC office.
