Enroll in WIC Form

Questions? Contact Us!

If you have questions that require immediate assistance, please call us at 1-866-327-3074. Our call center is open from 7:30 a.m. to 5:00 p.m. Monday through Friday.

Name*

First Middle Last

Are you homeless?*

Yes
No

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Family ID

If you are a current WIC participant, please provide your Family ID

Phone Number*

Email Address

What Would You Like To Do?*

Sign up for WIC
Reschedule my appointment

List the number of children under the age of five to be enrolled in WIC.

Are you pregnant?

Yes
No

What is your due date?

Are you currently breastfeeding?*

Yes
No

Are you and/or your children enrolled in Medi-CAL?*

Yes
No

Please Check The Box Below

Enroll in WIC Form

Enroll in WIC or Make an Appointment

Questions? Contact Us!