WIC | Request an Appointment

REQUEST A WIC APPOINTMENT

You may make an appointment by calling the department number directly, listed to the left, or by completing the form below. We will make every effort to respond to your appointment request as soon we receive it, within no more than 24-48 hours.

Your Name*

WIC ID Number (if known)

Street Address* Please include apartment or unit number.

City*

State*

Zip*

Your Email*

Your Phone Number*

Are you a new or existing WIC patient?*

Preferred Date(s)?
From:  
To:       

Preferred Time(s)?

Monday Tuesday Wednesday Thursday Friday
Morning
9 am - 12 pm
 Morning  Morning  Morning  Morning  Morning
Afternoon
12 pm to 5 pm
 Afternoon  Afternoon  Afternoon  Afternoon
Evening
5 pm to 7 pm
 Evening

How did you hear about us?*

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