Tri-County Health Department - Official Website

WIC Shopping Feedback or Request for Assistance

This form can be used to provide feedback about a shopping experience while using WIC benefits. It can also be used to request a phone call from WIC Staff for additional help.
Your Information and City of Residence.
First Name
Last Name
Would you like WIC Staff to contact you?*
Phone Number
Alternate Phone Number
Email
City You Live In
Grocery Store Information
Store Name and Location*
Do you have your store receipt from this transaction?*
Grocery store receipts can provide helpful information.
Please describe your shopping experience or how we can assist you.*
Upload Picture/Image Option
The system will allow one image to be uploaded of a product you thought should have been allowed with your WIC benefits. Send images of the product and the bar code located on the item. You may email additional images with your name to wic@tchd.org.
Note: Please be aware this form is not a secure method of communication. Please do not include information in this form you would like to remain confidential.
Thank-you for sharing your shopping experiences so WIC can continue to improve services to families in the community.
This institution is an equal opportunity provider.

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