Clinic Forms & Materials

What you can find...

Unless otherwise noted, all materials and forms on this page are in PDF format.

Ordering WIC Materials

Staff order WIC Nutrition Education and Breastfeeding Promotion materials, as well as program forms and materials, from the Department of Printing Fulfillment Center.

Visit www.prt.wa.gov and select “General Store”. Create or use an existing User Name and Password. Select “Shop by Department”. Select Department of Health, then WIC Program. Select the requested materials, add to cart and indicate the number needed, and complete the shipping information.

If you have any questions about WIC materials or have difficulty ordering online pleae contact Patty Mattinson at patty.mattinson@doh.wa.gov or 1-800-841-1410 ext. 3606.

Online Client Nutrition Education Flyers and Inserts:

• WICHealth.org Client Flyer (Word document, 175 KB)
• WICHealth.org Staff Flyer (Word document, 958 KB)
• WICHealth.org Insert (Word document, 120 KB)

Travel Forms and Reimbursement Information:

• A-19 Travel Reimbursement Form (63.13 KB)
• Authorization for Travel Form (28.63 KB)
• Travel & Lodging Reimbursement Information (96 KB)

WIC Checks and Foods Information:

• Copy of WIC store sign (17.70 KB)
• Formula Forms
  • WIC Clinic Response to Formula Requests (flow chart) (23.48 KB)
  • Process to Request Formula from Medicaid (47.17 KB)
  • WIC/Medicaid Nutrition Form (29.25 KB)
  • Medical Foods and Medical Formulas Form (85.99 KB)
• WIC Prescription Forms
  • Women (55.90 KB)
  • Infants (82.02 KB)
  • Children (92.08 KB)
• Using WIC Checks Flyer (87 KB):
  • Arabic (836 KB)
  • Chinese (102 5KB)
  • Korean (992 KB)
  • Russian (435 KB)
  • Somali (433 KB)
  • Spanish (651 KB)
  • Vietnamese (386 KB)
• WIC Clinic Response to Formula Requests (flow chart) (27.70 KB)
• New WIC Foods (effective October 1, 2009)
• WIC Foods (April 1, 2006 - December 31, 2009)
• WIC/Medicaid Nutrition Form (31.46 KB)

Miscellaneous:

• 2009 WIC Coordinator Calendar (130.91 KB)
• Certified Dietitian Application Information
• Easy IZ Guide (434.10 KB)
• Health Care Assistant Application Information
• WIC Coordinators Listserv
• WIC Annual Reports and Fact Sheets

Return to top

Documents posted in PDF version on the Department of Health Web site will be made available on request to users who are unable to download or view them. For persons with disabilities, PDF documents will be made available on request in other formats. To submit a request, contact WIC's Web Coordinator. Download the free PDF viewer here.

In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410 or call 800-795-3272 (voice) or 202-720-6382 (TTY). USDA is an equal opportunity provider and employer.

Washington WIC does not discriminate.

DOH Home | Access Washington | Privacy Notice | Disclaimer/Copyright Information

WIC Program
Washington State Department of Health
PO Box 47886
Olympia, Washington, 98504-7886

Last Update:  10/23/2009 01:47 PM
Send inquires about DOH and its programs to the Health Consumer Assistance Office.
Comments or questions regarding this web site? Send an email to the WIC Web Coordinator.