WIC Pediatric Referral
Form Template
The WIC Pediatric Referral mobile app provides a simple way for a health care provider to refer infants and children to the WIC program.
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Participation in the program helps give mothers, infants and children access to affordable, nutritious foods, along with access to nutrition education and health care services. The WIC referral form includes questions about the child's health, mom's feeding habits and more. Once completed, the referral can be emailed directly to your local WIC office for evaluation.
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