Forms

Many of the forms you need to help speed up the New York WIC application process are right here. Click on any of the links below to open or download the form you need.

Don’t see what you are looking for? Let us know and we will be happy to help.

If you would like to authorize another person to represent you at times when you are unable to attend WIC appointments or redeem food instruments, fill this form out. You are allowed to have up to two person to represent you but this is not required.

If you are looking to receive checks for special formula, please fill out this form.

Please fill out this form to authorize the transfer of information between your healthcare provider and WIC for your children.

Please fill out this form to authorize the transfer of information between your healthcare provider and WIC for yourself.

Clinic Closure

On Wednesday, April 26th the clinic will be open from 8:30am-12:30pm only. The clinic will be closed for the remainder of the day. We will reopen Thursday, April 27th at 8:00am.

Clinic Closure

WEDNESDAY APRIL 12TH The clinic be open from 8:30am-12:00pm only and closed in the afternoon. We will re-open on Thursday, April 13th at 8:00am.

Clinic Closed

The clinic will be closed Friday March 31st. It will reopen Monday April 3rd at 8:30am.