WIC Document Submission – MFHS

WIC Document Submission

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Status(Required)

Let’s get some basic information:

Name(Required)

First name Last name

Email address (optional)

Phone number(Required)

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What’s your WIC status?

WIC Card Number (optional)

Do you have medical assistance (state insurance), SNAP, or cash assistance?(Required)

Yes

No

What is your Access Card/PA State ID Number?

Where is your WIC center located?(Required)

Choose the center that best suits your needs:

Quakertown WIC Center – View Details

Warminster WIC Center – View Details

Bristol WIC Center – View Details

Choose the center that best suits your needs:

Berks WIC Nutrition Center – – View Details

Kutztown WIC Satellite Center – View Details

Choose the center that best suits your needs:

Towanda WIC Center – View Details

Choose the center that best suits your needs:

Carbon County WIC Center – View Details

Choose the center that best suits your needs:

Scranton WIC Center – View Details

MFHS Circle of Care Scranton – View Details

Childs WIC Center – View Details

Choose the center that best suits your needs:

Lehigh Valley WIC Center – View Details

Casa Guadalupe WIC – View Details

Choose the center that best suits your needs:

Hazleton WIC Center – View Details

Wilkes-Barre WIC Center – View Details

Choose the center that best suits your needs:

Tobyhanna WIC Center – View Details

East Stroudsburg WIC Center – View Details

Choose the center that best suits your needs:

Pottstown WIC Center – View Details

Colmar WIC Center – View Details

Norristown WIC Center – View Details

Choose the center that best suits your needs:

Hispanic Center of Lehigh Valley WIC – View Details

Easton WIC Center – View Details

Choose the center that best suits your needs:

Hamlin WIC Center – View Details

Choose the center that best suits your needs:

Sullivan Co Medical Ctr. (Temporarily Closed) – View Details

Choose the center that best suits your needs:

NEPA Community Health Care WIC – View Details

Choose the center that best suits your needs:

Shenandoah WIC Center – View Details

MFHS Pottsville Center – View Details

Tamaqua WIC Center – View Details

Choose the center that best suits your needs:

Wellsboro WIC Center – View Details

Choose the center that best suits your needs:

Hamlin WIC Center – View Details

Choose the center that best suits your needs:

Tunkhannock WIC Center – View Details

Who is receiving benefits?(Required)

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What’s your address?

Address(Required)

Street Address Street Address 2 City State Postal code

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Please upload your document:

Browse files(Required)

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, doc, txt, docx, xls, xlsx, csv, Max. file size: 64 MB.

Why are you filling out this form today? (optional)

I am new to WIC (click here for the documents needed for your first visit)

I am coming back to WIC (click here for the documents needed for your visit)

I am submitting a proof of pregnancy document

I am submitting a formula prescription

I am submitting height and weight documents

I am submitting blood work documents

Something else (referral or other documents)

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Please review your information and tap submit to send your information to a WIC Representative.
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