| WIC Downloads |
|---|
| WIC Formula Intolerance Checklist | 25 Kb | PDF | 3/28/07 |
| WIC
Formula Intolerance Checklist and information form about your infants characteristics | 413-528-0457 |
| |
| Request for Special Formula from WIC | 59 Kb | PDF | 3/28/07 |
| Request for Special Formula from WIC and Authorization for release of Information to WIC | 413-528-0457 |
| |
| WIC Medical Referral Form for Infants & Children | 56 Kb | PDF | 3/28/07 |
| 2 page form for Infants & Children information filled out by clinician, with parent /guardian
authorization | 413-528-0457 |
| |
| WIC Medical Referral Form for Women & Infants | 56 Kb | PDF | 3/28/07 |
| 2 page form for Women & Infants information filled out by clinician, with mother authorization | 413-528-0457 |
| |
