Northern Nevada Public Health

WIC Interest Form

Thank you for your interest in the Northern Nevada Public Health- WIC program.

WIC serves pregnant, breastfeeding, and postpartum women and children up to five years of age.

Please complete this interest form to request a WIC eligibility appointment.

Are you Pregnant or do you have children under the age of 5 years?

Yes - I am pregnant

Yes - I have children under 5 years of age

Yes - to both

What is your name?

Have you used any other names in the past?

What is your Date of Birth?

Do you know your due date?

Yes

Not applicable

When is your Due date?

What is your phone number?

What is your email address?

What is the best way to contact you?

Phone

What is your preferred location for the appointment?

1001 E. 9th Street, B Reno, Nevada 89512

601 W. Moana Lane, #3, Reno, Nevada 89509

880 Alder Ave #205, Incline, Nevada 89451

I understand that an employee from Northern Nevada Public Health- WIC program will contact me to determine eligibility.

Yes, I understand