For help in completing applications, please contact your nearest WIC office.

Please complete the GENERAL INFORMATION section only, then submit to your medical provider to complete the MEDICAL PROVIDER USE ONLY section of the form.

Once the form is completed, please return it to your nearest WIC office for an appointment.

Click on each form to download: (PDF)

Infants and Children
Pregnant Women
Breastfeeding and Postpartum Women

Get the free Adobe Reader:

WIC is a program of the Pennsylvania Department of Health with funds from the United States Department of Agriculture. WIC is an equal opportunity provider and employer.

Erie County WIC
556 W 4th Street Unit 102, Erie PA, 16507
Ph: 814-459-1948 ext 221 | Fax:814-456-8892 | E-mail Us | Contact Us
This institution is an equal opportunity provider.


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