Medical Providers
A physician’s prescription for special formula will NOT be accepted.
New Medical Documentation forms must be completed by a physician for infants to receive special WIC formula; for women and children 1 year and older to receive formula; or for customization of WIC foods for women and children with special dietary needs.
Medical Documentation Forms
- Infants and Children (file size 71k)
- Pregnant, Breastfeeding and Post-Partum Women (file size 68k)
- WIC approved formulas (file size 36k)
These WIC formulas do not require Medical Documentation for infants less than 12 months of age:
- Enfamil Premium LIPIL
- Prosobee LIPIL with Iron
- Gentlease LIPIL
- Enfamil AR LIPIL