WIC health care providers

Health care providers are required to submit medical documentation to WIC for WIC clients who require specialty formulas and WIC supplemental foods. USDA regulations don't allow electronic signatures. You may either print the form or download it electronically to your desktop. Then complete it, sign it and fax it to the WIC clinic or hand it to the WIC endorser or participant.
Map of local WIC clinics and agencies with contact information