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Participant Information

First Name

Last Name

Date of Birth

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Phone

WIC Family ID (8 Digits)

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Request Services

Select from the following categories:

Food Benefits (questions or changes to food package)

Breastfeeding (advice, or to request a pump)

Formula (questions or request change of formula)

Tell us more about your request

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• Our goal is to respond within two business days.
• We will let you know when your request is processed.
• Calls from WIC come up as restricted or no caller ID.

For other services, text us at 20121 or call us at 503-988-3503

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Medical Documentation Form

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If you experience issues with this form, please call 503-988-3503

Contact Information