Health Care Providers

WIC Prescription Forms – Formula and Food Authorization Form (FAFAF)

You may download the appropriate prescription form below. Please fill out completely and give to WIC client. You may also fax the form directly to the WIC clinic. For a list of WIC contact information click here.

Healthcare Provider LetterWIC Prescription Form for Infants (FAFAF) WIC Prescription Form for Children and Women (FAFAF)

WIC Referral Data Form 

You may download the referral form below. Please fill out the appropriate referral data and give to WIC client. You may also fax the form directly to the WIC clinic. For a list of WIC contact information click here. 

WIC Referral Data Form