The WIC Program provides services to pregnant women, new mothers, infants, and children up to five years of age who are at nutritional risk. Services are based on medical and income eligibility. The primary services provided are:
- Health screening and risk assessment
- Nutrition education and counseling
- Breastfeeding promotion and support. Check out our Breastfeeding Support page on FACEBOOK!
- Referrals to services specific to individual needs, such as health care providers and social services agencies
- Monthly instruments for nutritional, supplemental foods
Please visit the State of Missouri WIC website for information on income eligibility guidelines.
Forms and Documents
If you are an existing or prospective WIC client, save yourself time by printing and completing the appropriate forms and diet sheets below before visiting our office:
WIC Medicaid Release Form
Nutrition Assessment for Women
Nutrition Assessment for Infants
Nutrition Assessment for Children Ages 1-5
Evaluación de Nutrición Para Mujeres
Evaluación de Nutrición Para Bebes
Evaluación de Nutrición Para Niños de 1-5 Años
If your child has a medical condition that requires the use of special formula and conventional foods are precluded, restricted, and inadequate to meet his or her special nutritional needs, please ask your Medical Provider to complete the following form:
Medical Documentation - Health Care Provider Authorization
USDA Nondiscrimination Statement
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.
Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992.
Submit your completed form or letter to USDA by:
(1) Mail: U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410;
(2) Fax: (202) 690-7442; or
(3) Email: firstname.lastname@example.org.
This institution is an equal opportunity provider.