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Tri-County Health Department - Request a WIC Appointment

  1. WIC_logo_green_transparent

  2. Select One*

  3. Family Member Categories*

    WIC provides services to family members in the following categories. Please select all that apply to your family.

  4. (enter clinic name)

  5. (enter how you heard about WIC)

  6. (Include information that may be helpful to us such as language preference, need formula, need breastfeeding support, etc. )

  7. TCHD Website color Capture

  8. Leave This Blank:

  9. This field is not part of the form submission.